A case of unresectable pancreatic cancer showing tumor dormancy treated with gemcitabine

A 67-year-old woman visited our hospital with a chief complaint of epigastralgia. The patient was diagnosed as having unresectable pancreatic cancer because abdominal CT and angiography revealed a tumor that had invaded a common bile duct, portal vein and superior mesenteric vein. A palliative operation was performed because of obstructive jaundice. Peritoneal dissemination was observed and confirmed pathologically. The patient was treated with gemcitabine after the palliative operation. A gemcitabine 30 min i.v. infusion at a starting dose of 1,000 mg/m2 was administered once a week for 3 weeks with a 1-week rest. The patient experienced grade 2 leukocytopenia, so the dose of gemcitabine was reduced to continue the chemotherapy. The patient continued to undergo the palliative chemotherapy without severe adverse effects. As a result, the patient was in tumor dormancy for 15 months. It is important for the patient to induce an acceptable level of toxicity in clinical practice and to continue the chemotherapy.     

Progress of introduction of artificial respirator at home--the knowledge I have gained from a 19 year-old patient requiring a home respiratory management care and through the friendship with his family members

The patient developed right cerebellar hemorrhage at the age of 15 and spent four years at hospital. The patient and the family members had a strong wish to bring the patient back home and the patient was admitted to the hospital to undergo guidance about home medical care. The patient had paralysis of right upper and lower extremities and generalized strong ataxic motion and was under gastric feeding and had underwent tracheotomy to cope with hypoventilation, which required use of an artificial respirator at night hours. Since the patient was still as young as 19, we want to have the patient "go home" as they wanted. Fortunately, the mother who had to play key roles was still young and the parents worked at home. It didn't take long for them to master the techniques though they had various anxieties. It is considered important in the guidance on home medical care to what degrees the caregivers accept the condition of the patient and can imagine the long lasting care at home. We provided assistance while repeatedly interviewing with the patient and family members considering the significance to confirm their willingness and psychological condition. As a result, the patient was discharged from the hospital in two months. Now, two years have passed, and the patient is still cared at home and the possibility of the patient is sought for. The progress is reported here in this article.     

Radioimmunoassay of serum alpha-fetoprotein in patients with different maliganant tumors.

The level of serum alpha-fetoprotein (AFP) was estimated by radioimmunoassay in 153 normal healthy Malysians of different ethnic groups. The mean level was 7.5 In1/ml (SD 2.28InU/ml). Among 330 patients with malignant tumors, 11 had increased levels of AFP. The only patient who had hepatoma had a very high level of serum AFP. High levels were also found in three of four patients with dysgerminoma of the ovary, in the only two patients with carcinoma of the testis, and in one patient with secondary carcinoma of the humerus of unknown origin. Lower, but significantly increased levels were observed in one patient (of 48) with breast carcinoma, one patient (of 8) with basal cell carcinoma of the nose, one patient (0f 27) with carcinoma of the lung, and one patient (of 59) with nasopharynegeal carcinoma.     

Efficacy of vinorelbine and zoledronate combination therapy against postoperative recurrence of lung cancer

We report a case of a response to long-term treatment with vinorelbine and zoledronate in a patient with lymph node and multiple bone metastases after lung cancer surgery. CASE: The patient was a 70-year-old male initially examined by a local physician for an abnormal shadow that had been detected on a chest X-ray during a screening examination. CT revealed a mass shadow measuring 28 mm in diameter in the left S10, and because lung cancer was suspected, the patient was admitted to our hospital for the first time and examined. Lung cancer was diagnosed intraoperatively, and left lower lobectomy was performed. The pathological stage was III a, and postoperative adjuvant chemotherapy was performed, but recurrences in the form of lymph node and multiple bone metastases were detected. After diagnosis of the recurrence, the patient was treated with long-term vinorelbine (VNR)biweekly and zoledronate (ZOL) monthly, and a response was obtained. CONCLUSIONS: A patient with postoperative recurrence of lung cancer associated with multiple bone metastases responded to combination chemotherapy with VNR and ZOL. VNR was effective against postoperative recurrence in an elderly lung cancer patient with complications, and could be administered safely long-term. ZOL also had a favorable protective effect against skeletal-related events (SREs) in lung cancer, and the results suggested that it also had an antitumor effect in this patient.     

Relationship between epidemiologic and endocrinologic aspects of cervical cancer.

In search of etiologic relevancy of the steroid deviations in urine, we compared the reproductive activities of patients having cervical cancer with those of normal controls. A premenopausal patient experienced the birth of her first child significantly earlier than did the urban control of corresponding age, despite their similarity of age at menarche. However, when the same patient was compared with the premenopausal rural control, this differences was not found. The same parameter also failed to differentiate a postmenopausal patient from the corresponding control of urban origin. The premenopausal patient who was indistinguishable from the rural control by age at first delivery was distinguished from the rural control by reduced excretions of adrenal steroids including 11-deoxy-17 ketosteroids and some corticosteroid metabolites. The spectrum and the degree of deviation of urinary steroids for a patient coincided with the spectrum and the degree of age dependency of the urinary steroids for a normal woman during and after adolescence. These findings indicated that the inability of the reproductive parameter to discriminate a patient was associated with growth retardation in a population, and a maturation deficiency of the adrenal gland (arrest of adrenarche) was implicated in the genesis of cervical cancer.     

以CD56+小肠粒细胞肉瘤为首发表现的急性单核细胞白血病1例并文献复习

目的 探讨粒细胞肉瘤的发病机制、诊治与转归。方法分析1例以CD56+小肠粒细胞肉瘤为首发表现的急性单核细胞白血病患者的临床病理特征及实验室检查结果,并复习相关文献。结果 收治1例男性患者,39岁。小肠系膜切除物免疫组化检测示：粒细胞肉瘤,CD56阳性;骨髓细胞学检查示：急性单核细胞白血病,诊断为急性单核细胞白血病伴小肠粒细胞肉瘤。经IA方案诱导化疗后疾病达完全缓解,继续IA方案巩固化疗,拟行异基因造血干细胞移植。结论以小肠粒细胞肉瘤为首发表现的急性白血病较为少见。粒细胞肉瘤的预后差,CD56抗原阳性提示预后不良,经诱导化疗获疾病缓解的患者应尽快行异基因造血干细胞移植以期达到长期生存。     

Redistribution of concanavalin a receptors on peripheral blood lymphocytes of myeloma patients

Redistribution of Con A receptors was studied on peripheral blood lymphocytes from 9 apparently healthy individuals and 12 myeloma patients using FITC-conjugated Con A. The diagnosis was made on the base of clinical, cytological, and serological criteria. It was found that in the patient group receptor redistribution measured by “cap” formation was significantly lower than in the normal group (p < 0.005).

Chemically modified Con A molecules with reduced valence were prepared and used in double immunofluorescence experiments together with anti-Ig antibodies. Cells of three categories according to the presence of Con A receptors and SmIg receptors were scored in a myeloma patient, in a macroglobulinemia patient and two normals. Impaired “cap” formation was found in the myeloma patient under these experimental conditions also. Another result was that SmIg receptors were co-redistributed with Con A receptors on cells from the myeloma patient as from normals. In the macroglobulinemia patient 22% of the mononuclear cells from the peripheral blood carried SmIg receptors only, that is not associated with Con A receptors. Cells of this type were missed in two normals and the myeloma patient.     

Collaborative/active participationper se does not decrease anxiety in breast cancer

The information needs of breast cancer patients on their disease, its treatment, the prognosis, and their attitude to decision-making concerning treatment were assessed. One hundred and fifty early and 45 metastatic breast cancer patients were recruited into the study. The amount of information and role in the treatment decision-making process preferred by the patient were independently estimated by the patient and the oncologist, using questionnaires. Information was provided in accordance with the wishes of the patient as perceived by the physician. Test of anxiety was performed before, and one week after the consultation. Most of the patients claimed to anticipate the provision of extensive information and an active role in the decision-making, but real interest during the consultation was found less frequently. The post-consultation anxiety test revealed a significant decrease in situational anxiety; this was not related to the patient’s information needs or her attitude to the decision-making concerning treatment. Our study demonstrates that a significant decrease in anxiety may be achieved via a consultation tailored to the needs of the patient. Loading the patient with information and involvement in the decision regarding therapy as much as the patient seems comfortable with lowers distress.     

Cutaneous T-cell lymphoma in a patient infected with human immunodeficiency virus type 1. Use of radiation therapy

A patient with cutaneous T-cell lymphoma (CTCL) and acquired immune deficiency syndrome (AIDS) is presented. The patient had a localized lesion on his scalp. Evaluation for systemic lymphoma was negative. A biopsy specimen showed superficial and deep dermal infiltrates of pleomorphic lymphocytes. Immunohistochemistry was consistent with T-cell lymphoma. The patient was treated successfully with local irradiation. He remained free of further systemic and cutaneous recurrences of the lymphoma until he died 8 months after treatment of pneumonia. This case is the first to our knowledge to describe a localized CTCL in a patient infected with human immunodeficiency virus type 1 (HIV-1).     

体部γ2刀治疗原发性肝癌的疗效分析

 目的　观察γ刀治疗原发性小肝癌的远近期疗效和放疗不良反应。方法　37 例原发性小肝癌 患者采用体部γ刀放疗。50 %～60 %等剂量线包绕PTV ,60 %～70 %等剂量线包绕GTV ,GTV 生物等 效剂量达80 Gy 以上。27 例患者配合TACE 1～2 次。结果　完全消失9 例,部分缓解22 例,稳定4 例, 进展2 例。肿瘤局控率83. 78 % (31/ 37) , 1 ～5 年生存率分别为78. 38 % (29/ 37) , 62. 16 % ( 23/ 37 ) , 43. 24 %(16/ 37 ) , 32. 43 % ( 11/ 37) , 33. 3 % ( 5/ 15) 。平均生存期为31 月。单发病灶4 年生存率达 55. 56 %(11/ 20) ,疗效与根治手术生存情况相接近,不良反应可以耐受。结论　对于拒绝手术或不能手 术的原发性小肝癌患者,体部γ刀不失为一种较为有效的根治治疗手段,但合适的总剂量和分次剂量尚 需进一步探讨。     

Complete response of an HIV negative gastric Kaposi's sarcoma (KS) patient with peritoneal carcinomatosis by liposomal daunorubicin treatment

We report the first case of an HIV negative patient with gastricKaposi's sarcoma (KS) and peritoneal carcinomatosis in whom a completeresponse (CR) was obtained after liposomal daunorubicin administration. Thepatient presented with epigastric pain and hematemesis. Upper gastricendoscopy with multiple biopsies showed gastric involvement by KS. The wholephysical examination and the thoraco-abdomino-pelvic CT scans showed no otherlocalization. A total gastrectomy was performed. Histological examinationconfirmed the diagnosis of KS with involvement of regional lymph nodes andperitoneal lesions. Six cycles of liposomal daunorubicin were given.Post-treatment coelioscopic control was normal. The patient received anothersix adjuvant cycles of liposomal daunorubicin. The patient is in completeremission six months after the end of treatment. Liposomal daunorubicin isa promising treatment in the non HIV patient with visceral KS.     

Two cases of disseminated Trichosporon beigelii infection treated with combination antifungal therapy

Two patients with acute leukemia in whom disseminated Trichosporon beigelii infection developed are reported. The T. beigelii infection developed in the first patient while he was receiving 5-fluorocytosine. He was treated with amphotericin B in addition to 5-fluorocytosine. Despite the continued antifungal therapy, multiple organs were invaded by the organisms at autopsy. The second patient was treated with miconazole and norfloxacin. Although this combination antifungal therapy seemed to be effective, this patient required splenectomy for cure of the infection.     

A very rare adult case with neuroblastoma

We report a 53-year-old male patient who underwent paravertebral mass excision at the D10-11-12 vertebral levels in 2007. The histopathological evaluation of the mass showed the presence of neuroblastoma. The patient was diagnosed with stage IV neuroblastoma. He received 6 courses of chemotherapy and exhibited a stable course until March 2010. When he was reevaluated in March 2010, progression in the metastatic lesion as well as local recurrence was detected. The patient, who was restarted on chemotherapy, developed progressive weakness and loss of sensation of the lower extremity. The neurosurgical investigation revealed an irreversible loss in motor functions. The patient is currently on symptomatic treatment.     

CD19及CD22嵌合抗原受体T细胞序贯治疗复发难治纵隔B淋巴母细胞淋巴瘤一例并文献复习

目的探讨CD19及CD22嵌合抗原受体T细胞(CAR-T)序贯治疗复发难治纵隔B淋巴母细胞淋巴瘤(B-LBL)的效果。方法报道华中科技大学同济医学院附属同济医院2017年3月收治的1例经CD19及CD22 CAR-T序贯治疗的复发难治纵隔B-LBL患者,分析CD19及CD22 CAR-T序贯治疗后1、3、6、12、18个月原发病缓解相关指标,并复习相关文献。结果该患者经过三线化疗后疾病复发进展,后行CD19及CD22CAR-T序贯治疗。在细胞免疫治疗过程中,患者出现1级细胞因子释放综合征,经积极治疗,病情稳定后出院。患者定期来院复查,动态追踪观察纵隔包块。行CAR-T治疗后患者纵隔包块明显缩小,病情持续缓解达18个月。结论 CD19及CD22 CAR-T序贯治疗为复发难治B-LBL提供了新的治疗手段。对于常规化疗效果欠佳的患者,应尽早积极行CAR-T治疗,从而提高缓解率,改善患者的远期预后。     

健择联合卡铂治疗70岁以上进展期非小细胞肺癌患者的观察

目的观察健择联合卡铂方案治疗70岁以上老年进展期非小细胞肺癌(NSCLC)患者的疗效及副反应,评价该方案的可行性。方法对采用健择联合卡铂化疗的44例进展期NSCLC患者(初治)进行回顾性分析,其中70岁以下24例,70岁以上20例。化疗方案:<70岁健择1200mg/m2,d1,8;卡铂AUC=5,d1;≥70岁健择1000mg/m2,d1,8;卡铂AUC=4,d1。每3周重复,至少治疗2周期,2周后评价疗效。结果70岁以下组共完成89周期化疗,平均3.7周期,有效率(CR+PR)45.8%,70岁以上组共完成66周期,平均3.3周期,有效率(CR+PR)40.0%,两组近期有效率比较差异无统计学意义(P>0.05)。两组在Ⅲ~Ⅳ骨髓抑制、严重恶心呕吐、脱发、肝肾功能损害方面差异无统计学意义(P>0.05),70岁以下组严重便秘1例,70岁以上组5例,差异有统计学意义(P<0.05)。两组中分别有2例患者化疗后血小板明显升高,1例56岁男性患者发生双下肢深静脉血栓,抗凝治疗后好转。结论健择联合卡铂化疗治疗70岁以上进展期NSCLC,疗效较好,毒副反应可耐受。     

Extraventricular anaplastic ependymoma with metastasis to scalp and neck

We report a case of anaplastic ependymoma with extracranial metastases in a 22-year-old female. The patient originally presented with headaches and dysarthria. Neuroimaging revealed a large solid and cystic right fronto-temporal lesion. It was located completely extraventricularly and a glioblastoma was suspected based on the neuroimaging findings. A gross total resection was achieved. Histopathologic examination revealed an anaplastic ependymoma. The patient was treated with radiotherapy. Approximately 1 year after the initial surgery, the patient presented with metastatic disease to the scalp. At 2 years, an intraparotid metastasis was detected. Subsequent neck dissection revealed positive lymph nodes at several levels. It was followed by radiotherapy to the neck. 5 years after the initial surgery, the patient has residual metastatic disease. The case is discussed and the literature on extraventricular ependymal neoplasms is reviewed.     

Dose-finding study of weekly docetaxel plus estramustine in patients with hormone-refractory metastatic prostate cancer

OBJECTIVE: The aim of this phase I study was to find the maximum tolerated dose of weekly docetaxel in association with estramustine in hormone-refractory prostate cancer. METHODS: Eleven patients with hormone-refractory prostate cancer were treated with escalating weekly doses of docetaxel (level I, 3 patients, 30 mg/m2; level II, 3 patients, 35 mg/m2, level III, 3 patients, 40 mg/mz; level IV, 2 patients, 45 mg/m2) associated with fixed dosage of estramustine (840 mg/day). RESULTS: In level I, there was only one episode of grade 3 neutropenia; grade 1 nausea and vomiting were registered in 1 patient; in 1 patient mild edema of the lower limbs was noted. In level II, grade 2 stomatitis and grade 1 sensory symptoms occurred in 1 patient, and grade 1 edema in 1 case. In level Ill, grade 2 edema was noted in 2 patients, damage to nails in 1 patient, asthenia in 1 patient, grade 1 neuropathy in 2 patients, and grade 1 nausea in 1 patient. In level IV, grade 2 edema was present in 1 patient, grade 3 edema in 1 patient, changes with fall of nails and grade 2 erythema of face in 2 patients, asthenia in 2 patients, grade 1 neuropathy in both patients. Nine patients had a more than a 50% decrease in PSA after 2 cycles of therapy. CONCLUSIONS: The results of the study suggest a good tolerability of weekly 35 Mg/m2 docetaxel in hormone-refractory prostate cancer in association with estramustine.     

A case of multiple bone metastasis of gastric carcinoma accompanying DIC successfully controlled with combination of S-1 and low-dose CDDP

The patient was a 50-year-old man who underwent total gastrectomy twelve years ago. Ahigh level of ALP was found in the patient in April 2008. Based on various examinations, the diagnosis of multiple bone metastasis of gastric carcinoma accompanying disseminated intravascular coagulation(DIC)was made. The patient was treated with S-1/CDDP. S-1(80mg/ m / / 2day)was administered for 14 days followed by a 7-day rest period, and a CDDP(20mg/m2)infusion was administered on days 1 and 8. After one course of treatment, the DIC was controlled, and the patient was given a one-year prognosis. The combination of S-1 and low-dose CDDP may be considered effective even for multiple bone metastases of gastric carcinoma with DIC.     

Acute abdomen due to granulocytic sarcoma of the terminal ileum

A 57-year-old patient with chronic granulocytic leukemia in blast crisis and severe neutropenia is presented. This patient developed right sided peritonitis due to an isolated transmural granulocytic sarcoma of the terminal ileum. The affected segment was resected and the patient survived 4 more months. Thus, despite neutropenia, an aggressive surgical approach should be considered in a leukemic patient presenting with unexplained acute abdomen, since, as demonstrated here, a localized lesion which could not have otherwise been detected, was ultimately found and promptly resected.     

Malignant fibrous histiocytoma of the scrotal wall--a case report

The case involves a 64-year-old male who was found to have a gradually enlarging tumor which was responsible for a slight tenderness in his scrotum for a month. Tumor excision was performed, and the tumor size was found to be 3 X 2 X 2 cm. A histologic examination of this tumor revealed a malignant fibrous histiocytoma of the scrotal wall. The patient received UFT chemotherapy. Five months after the excision, the patient was rehospitalized with a local recurrence in the scrotum. After a second operation, the patient was treated with radiotherapy.