Carmustine (BCNU) implants (Gliadel(®) Wafer, Eisai Inc., New Jersey, USA) for the treatment of malignant gliomas (MGs) were shown to enhance overall survival in comparison to placebo in controlled ...clinical trials in the United States and Europe. A prospective, multicenter phase I/II study involving Japanese patients with MGs was performed to evaluate the efficacy, safety, and pharmacokinetics of BCNU implants. The study enrolled 16 patients with newly diagnosed MGs and 8 patients with recurrent MGs. After the insertion of BCNU implants (8 sheets maximum, 61.6 mg BCNU) into the removal cavity, various chemotherapies (including temozolomide) and radiotherapies were applied. After placement, overall and progression-free survival rates and whole blood BCNU levels were evaluated. In patients with newly diagnosed MGs, the overall survival rates at 12 months and 24 months were 100.0% and 68.8%, and the progression-free survival rate at 12 months was 62.5%. In patients with recurrent MGs, the progression-free survival rate at 6 months was 37.5%. There were no grade 4 or higher adverse events noted due to BCNU implants, and grade 3 events were observed in 5 of 24 patients (20.8%). Whole blood BCNU levels reached a peak of 19.4 ng/mL approximately 3 hours after insertion, which was lower than 1/600 of the peak BCNU level recorded after intravenous injections. These levels decreased to less than the detection limit (2.00 ng/mL) after 24 hours. The results of this study involving Japanese patients are comparable to those of previous studies in the United States and Europe.
We report an extremely rare case of hepatocellular carcinoma accompanied by sarcoid reaction in regional lymph nodes. A 67-year-old man with chronic hepatitis C admitted for back pain had serum ...α-fetoprotein elevated to 60ng/ml. Abdominal ultrasonography showed a hyperechoic tumor about 4cm in diameter in segment 5 of the liver. Dynamic bolus computed tomography (CT) showed peripheral enhancement of the tumor, accompanied by enlarged lymph nodes around the common hepatic artery and the inferior vena cava. Hepatic arteriography showed tumor staining, and CT during arterioportography showed a perfusion defect, yielding a diagnosis of hepatocellular carcinoma. Transcatheter arterial embolization (TAE) of the right hepatic artery was conducted, followed by microwave coagulation therapy to the liver tumor with lymph node dissection under laparotomy. Microscopically, biopsy specimens of the liver tumor showed poorly differentiated hepatocellular carcinoma, and dissected lymph nodes involved tumor metastasis including marked epithelioid granulomas.
A RECURRENT CASE OF PRIMARY SMALL INTESTINAL VOLVULUS YAMAZAKI, Masanao; NITTA, Atsunori; YAMADA, Shinobu ...
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association),
2006, Letnik:
67, Številka:
7
Journal Article
Odprti dostop
An 83-year-old woman was seen at the hospital for sudden vomiting and a sense of abdominal discomfort. The patient was diagnosed with primary small intestinal volvulus when abdominal computed ...tomography (CT) demonstrated a “whirl sign” in the small intestine loops around the superior mesenteric artery (SMA). In emergency surgery, the jejunum and ileum were twisted 360° counterclockwise around the SMA, and the intestine caused ischemic change. The blood flow recovered quickly after detorsion, eliminating the need for intestine resection. But three months later, the patient was seen at the hospital for the same symptom again. We diagnosed primary small intestinal volvulus recurrence because abdominal CT demonstrated the “whirl sign”. Again, the jejunum and ileum twisted 360° counterclockwise around the SMA. The blood flow recovered quickly after detorsion, but we added bowel fixation to prevent a recurrence. There are a few reports of recurrence, but the necessity of small intestine fixation was suggested in cases of primary small intestinal volvulus.
We present a case of gastrointestinal stromal tumor (GIST) of the rectum. A 55-year-old man was admitted to the hospital because of a rectal tumor detected at a medical checkup in April 2003. Digital ...examination revealed an about 3-cm sized elastic-hard mass with a smooth surface, locating about 3cm oral from the anal verge. Colonoscopic examination showed a submucosal tumor encircling about 1/4 of the lumer in the lower rectum which had the smooth surface without ulcer. A transanal core needle biopsy was performed. HE staining showed a solid growth of spindle-shaped cells, and immunohistochemically the tumor cells were positive for CD34 but negative for SMA and S100. GIST was thus diagnosed. Considering that lymph node dissection was unnecessary and the anal function was able to be preserved, we performed a transsacral partial resection of the rectum. No local recurrence or distant metastasis has occurred, as of 20 months after the operation.
Abstract Carmustine (BCNU) implants (Gliadel(R) Wafer, Eisai Inc., New Jersey, USA) for the treatment of malignant gliomas (MGs) were shown to enhance overall survival in comparison to placebo in ...controlled clinical trials in the United States and Europe. A prospective, multicenter phase I/II study involving Japanese patients with MGs was performed to evaluate the efficacy, safety, and pharmacokinetics of BCNU implants. The study enrolled 16 patients with newly diagnosed MGs and 8 patients with recurrent MGs. After the insertion of BCNU implants (8 sheets maximum, 61.6 mg BCNU) into the removal cavity, various chemotherapies (including temozolomide) and radiotherapies were applied. After placement, overall and progression-free survival rates and whole blood BCNU levels were evaluated. In patients with newly diagnosed MGs, the overall survival rates at 12 months and 24 months were 100.0% and 68.8%, and the progression-free survival rate at 12 months was 62.5%. In patients with recurrent MGs, the progression-free survival rate at 6 months was 37.5%. There were no grade 4 or higher adverse events noted due to BCNU implants, and grade 3 events were observed in 5 of 24 patients (20.8%). Whole blood BCNU levels reached a peak of 19.4 ng/mL approximately 3 hours after insertion, which was lower than 1/600 of the peak BCNU level recorded after intravenous injections. These levels decreased to less than the detection limit (2.00 ng/mL) after 24 hours. The results of this study involving Japanese patients are comparable to those of previous studies in the United States and Europe.
In early modern Japan, fish meal made from herring was used as a fertilizer in cash crop production. Herring meal was produced in the northernmost island, Hokkaido, and shipped in kitamaebune ...(vessels operated by independent shippers and merchants involved in the herring trade) to ports in Honshu (the main island of Japan). This paper examines a shift in the system by which herring cargoes from Ezochi were collected in the Matsumaechi port town of Esashi between 1865 and 1869. Matsumaechi was the southwestern periphery of Hokkaido; it was distinguished politically from the rest of the island (known as Ezochi) during the Edo period. Esashi was the center of the herring trade on the west coast of Hokkaido. This study is based upon the records of Sekigawa Yozaemon, an Esashi herring-meal merchant. The Matsumae domain recognized Sekigawa as a wholesaler (Esashi ton'ya) and granted him a contract to collect commodity taxes and port charges levied on commodities and boats passing through the Esashi customs house (Okinokuchi yakusho). Accordingly, the Sekigawa records can be regarded as official documents: they offer extremely detailed information concerning the shipping of herring by-products. The study's findings, based on an analysis of the records, can be summarized as follows: The Esashi ton'ya had monopoly rights to herring from western Ezochi during the first half of the nineteenth century. These rights derived from their roles as supply merchants, in which they provided loans to fishers living in and around Esashi in return for exclusive access to the herring caught by their clients in western Ezochi. However, when eight villages along the northern coast of Matsumaechi between Esashi and the Ezochi border came under the direct administration of the Tokugawa Shogunate in 1855, the ship owners and fishers in the villages were permitted to trade directly with other districts, including the Tohoku region and other parts of Honshu. In other words, they were allowed to fish and trade herring independently of the Esashi ton'ya. This led to an upheaval in the system of collecting herring in Esashi. In 1864, the eight villages were returned to the Matsumae domain, with the result that all ships from Ezochi once again had to discharge their cargoes at Esashi. Ship owners and fishers living in the eight villages opened branch stores in Esashi, through which they started selling herring meal directly to the Esashi ton'ya, without borrowing money or supplies such as nets and boats from them. At the same time, the number of kitamaebune entering from Honshu peaked: they were employed by Esashi merchants in shipping herring loads from Ezochi to Esashi. Consequently, the function of collecting herring became concentrated in Esashi once again. In sum, systems for collecting herring loads from Ezochi to Esashi were reorganized by merchants, kitamaebune ship owners, and fishers living in and around Esashi between 1865 and 1869.
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