Safe Concurrent Use of Anti-tuberculosis Drugs and Pembrolizumab in a Patient with Non-small-cell Lung Cancer Who Was Infected with Mycobacterium tuberculosis

A 68-year-old Japanese man was diagnosed with lung adenocarcinoma stage IVB. We introduced a first-line chemotherapy of four cycles of carboplatin and pemetrexed and pembrolizumab, followed by pemetrexed and pembrolizumab maintenance therapy. Approximately four months after anticancer therapy, a small nodule appeared in the right peripheral S3 lesion. After five months, the nodule was confirmed as a Mycobacterium tuberculosis (TB) nodule. We initiated anti-TB therapy without stopping pembrolizumab, and the right S3 nodule shrank immediately. This report supports the concurrent use of anti-TB treatment with an immune checkpoint inhibitor when the TB infection area is limited.     

Pancreas-Sparing Duodenectomy for a Recurrent Retroperitoneal Liposarcoma: Report of a Case

Pancreas-sparing duodenectomy (PSD), which allows preservation of the pancreas in its entirety, is a promising procedure for low-grade malignancies of the duodenum, the periampullary region, and the neighboring retroperitoneum. We report a case of recurrent retroperitoneal liposarcoma involving the second and third parts of the duodenum, which was extirpated using PSD, after a right hemicolectomy for tumor invasion of part of the colonic hepatic flexura. The Roux-en-Y jejunal limb was sutured to the duodenal bulb in an end-to-end fashion, and the biliary and pancreatic duct systems were reconstructed with end-to-side anastomoses, placing the jejunal limb distal to the bulbo-jejunostomy after a septoplasty to repair the adjacent pancreatic and biliary ducts. Because retroperitoneal liposarcoma has a low incidence of lymph node metastasis, pancreaticoduodenectomy may be inappropriate, especially if minimally extensive surgery can ensure organ preservation. Pancreas-sparing duodenectomy could be the most appropriate procedure for nonepithelial malignant tumors located around the duodenum distal to the pylorus, which have no involvement with the pancreatic parenchyma or periduodenal lymph nodes.     

Continuing Medical Education Activity in Echocardiography

Article Title: Speckle Tracking Global Strain Rate E/E’ Predicts LV Filling Pressure More Accurately Than Traditional Tissue Doppler E/E’ (Echocardiography, 2012;29:403)     

Simultaneous acquisition of iodine-123 emission and technetium-99m transmission data for quantitative brain single-photon emission tomographic imaging

The aim of this study was to obtain quantitative iodine-123 brain single-photon emission tomographic (SPET) images with scatter and attenuation correction. We used a triple-headed SPET gamma camera system equipped with fan-beam collimators with a technetium-99m line transmission source placed at one of the focal lines of the fan-beam collimators. Four energy windows were employed for data acquisition: (a) 126–132 keV, (b) 132–143 keV, (c) 143–175 keV and (d) 175–186 keV. A simultaneous transmission-emission computed tomography scan (TCT-ECT) was carried out for a brain phantom containing ¹²³I solution. The triple energy window scatter correction was applied to the ¹²³I ECT data measured by means of the windows (b), (c) and (d) acquired by two detectors. Attenuation maps were reconstructed from ^99mTc TCT data measured by means of the windows (a), (b) and (c) acquired by one detector. Chang’s iterative attenuation correction method using the attenuation maps was applied to the ¹²³I ECT images. In the phantom study cross-calibrated SPET values obtained with the simultaneous mode were almost equal to those obtained with the sequential mode, and they were close to the true value, within an error range of 5.5%. In the human study corrected images showed a higher grey-to-white matter count ratio and relatively higher uptake in the cerebellum, basal ganglia and thalamus than uncorrected images. We conclude that this correction method provides improved quantification and quality of SPET images and that the method is clinically practical because it requires only a single scan with a ^99mTc external source. Received 6 June and in revised form 27 July 1998     

Hepatectomy based on the tumor hemodynamics for hepatocellular carcinoma: a comparison among the hybrid and pure laparoscopic procedures and open surgery

Purpose

This study was designed to evaluate the surgical parameters and treatment outcomes of tumor hemodynamics-based pure laparoscopic (PURE) and laparoscopy-assisted (HYBRID) hepatectomy for small hepatocellular carcinoma (HCC) compared with those of open hepatectomy.

Methods

Using a prospectively collected database from 1997 to 2011, we analyzed the data of 56 consecutive cases of laparoscopic hepatectomy for HCC (PURE, n = 24; HYBRID, n = 29; HALS, n = 3) from among 102 cases undergoing laparoscopic hepatectomy. We employed 27 cases treated by open hepatectomy during the same period as controls.

Results

PURE was associated with lesser blood loss, lower weight of the resected liver, and a shorter skin incision than HYBRID and open hepatectomy [median blood loss (mL): PURE 7, HYBRID 380, Open 450; P < 0.05]. On the other hand, HYBRID hepatectomy was associated with a longer operation time [operation time (min): HYBRID 232, Open 185; P = 0.0226]. The length of hospitalization in the cases treated by PURE and HYBRID hepatectomy was shorter than that in the cases treated by open hepatectomy [length of hospitalization (days): PURE 11, HYBRID 12, Open 17; P < 0.05]. One case each of transfusion and morbidity was recorded in this series. There was no significant difference of the overall (OS) or disease-free survival (DFS) between the patients treated by laparoscopic and open hepatectomy (3-year OS: 100 vs. 100 %; DFS 50 vs. 62 %, respectively).

Conclusions

Neither the surgical parameters nor the treatment outcomes of hemodynamics-based laparoscopic hepatectomy were inferior to those of open hepatectomy.     

Clinical significance of exercise-induced ST segment depression in patients with lateral myocardial infarction involving the left circumflex artery: evaluation by exercise 99mTc-MIBI myocardial scintigraphy

PURPOSE: The aim of this study is to clarify the causes of exercise-induced ST-segment depression in patients with broad lateral old myocardial infraction involving LCX (LCX-OMI) without ischemia on exercise scintigraphy. METHOD: Twenty one patients (M/F = 11/10, age = 62 +/- 19 years) with myocardial infraction involving LCX (LCX-MI), but without fill-in on exercise and rest MIBI quantitative gated SPECT (QGS), were selected. They were divided into two groups of Group ST(+) (n = 11, with significant ST depression (max -2.8 +/- 0.4 mm), Group ST(-) (n = 10) without ST depression. On 20 SPECT segments of both exercise and rest SPECT, we scored uptake score as DS (0 = normal to 3 = defect) and wall motion as WMS (0 = normal to -5 = dyskinesis) and summed DS (TDS) and WMS (TWMS) in LCX region, furthermore, calculated the difference of TWMS (delta TWMS [exercise-rest]), end diastolic volume (EDV) and ejection fraction (EF) during exercise were compared between the two groups. RESULT: Group ST(+) showed significantly (p < 0.01) lower EF (35.4 +/- 9.2% vs. 60.2 +/- 6.2%), larger EDV (146 +/- 53 ml vs. 93 +/- 15 ml), higher TDS (5 vs. 7 +/- 3), lower TWMS (-25 +/- 9 vs. -6 +/- 5), furthermore lower delta TWMS (-6.9 +/- 4.0 vs. -2.0 +/- 0.8) than Group ST(-). CONCLUSION: Exercise-induced significant ST depression in V2-4 without ischema in LCX-MI was observed in patients with broad LCX-MI, low EF, and was related to impaired wall motion in LCX region. ST depression in V2-4 was considered to appear as miller image of ST elevation at postero-inferior wall due to disturbed wall motion on exercise.