A case of colon cancer with long-term survival treated by resection of recurrence on the rectum and chemotherapy for lung metastasis

A 69-year-old male was operated on sigmoidectomy for sigmoid colon cancer (SS, N2, H0, P0, M0, stage IIIb) 7 years ago. Two years later, he was diagnosed for rectal cancer and bilateral lung metastases by TBLB. We performed Mile's operation, and the rectal focus was pathologically diagnosed with a recurrence of sigmoid colon cancer. After surgery, chemotherapy with FOLFOX was started for bilateral lung metastases, resulting in CR during the 22 months. But bilateral lung metastases were exacerbated, and then we administered several other chemotherapies. Five years have passed since chemotherapy started, although the focuses tended to progress. Right now, he has been a chemotherapy outpatient for last 5 years.     

A case of the long-term survivor of rectal cancer who suffered from successive metastases to ovarium, peritoneum, liver, bone and para-aortic lymphonode

A 37-year-old female, who had undergone a low anterior resection for lower rectal cancer, had been received chemotherapy (FOLFOX4, FOLFIRI) for 2 years because of right ovarian metastasis occurred and removed 9 months after the first operation. One month after 2 years of continued chemotherapy, progressive metastases happened to occur successively (rt lunge, left ovarium, liver, para-aortic lymphonode, Virchow lymphonode and bone). Right upper lobe pnemonectomy was performed first, then, peritonectomy, total hysterectomy with left oophorectomy and a partial resection of the small bowel were done. IRIS, as postoperative chemotherapy, performed with hepatic arterial infusion (HAI) of CPT-11 and 5- FU resulted in getting a minimal response for about 10 months. Because of the hepatic arterial thrombosis at 10 months after the previous operation, we could not continue HAI with systemic chemotherapy, that was resulted in the progresion of mutiple metastases, and that the patient died 62 months after the first surgery. Immunohistochemical analyses with MIB-1 stainning of four surgical specimens revealed 80% positive cells in the cancerous tissues.     

iNOS-dependent DNA damage in patients with malignant fibrous histiocytoma in relation to prognosis

Malignant fibrous histiocytoma (MFH) is one of the most common soft tissue sarcomas. MFH has been proposed to be a lesion accompanied with inflammatory responses. During chronic inflammation, reactive nitrogen and oxygen species generated from inflammatory cells are considered to participate in carcinogenesis by causing DNA damage. 8-nitroguanine is a mutagenic nitrative DNA lesion formed during chronic inflammation. We examined whether nitrative DNA damage is related to the prognosis of MFH patients. We performed immunohistochemical analyses to examine the distribution of DNA damage and the expression of inflammation-related molecules including inducible nitric oxide synthase (iNOS), nuclear factor-kappaB (NF-kappaB), and cyclooxygenase-2 (COX-2) in clinical specimens from 25 patients with MFH. We also analyzed the correlation of DNA damage or the expression of these genes with the prognosis of MFH patients. Immunohistochemical staining revealed that the formation of 8-nitroguanine and 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodG), an oxidative DNA lesion, occurred to a much greater extent in MFH tissue specimens from deceased patients than in live patients. iNOS, NF-kappaB and COX-2 were colocalized with 8-nitroguanine in MFH tissues. It is noteworthy that the statistical analysis using the Kaplan-Meier method demonstrated strong 8-nitroguanine staining to be associated with a poor prognosis. In conclusion, 8-nitroguanine appears to participate in not only the initiation and promotion of MFH, but also in the progression of MFH, and could therefore be used as a promising biomarker to evaluate the prognosis of cancer patients.     

Progression of gastric cancer observed for three and a half years under S-1 administration

A 60-year-old male patient noticed a sudden epigastric pain and visited our hospital for treatment. Active gastric ulcer was discovered by a routine gastrointestinal endoscopy. Moderately differenciated tubular adenocarcinoma was confirmed by biopsy and was advised to take surgical treatment. However, he refused to go on with gastrectomy and selected to take S-1 as an oral anti-tumor drug instead. Despite many approaches to convince the patient to have surgery, three and a half years passed. Macroscopic findings have changed from 0-IIc type to infiltrating advanced type cancer. Finally, we persuaded him to take a surgical resection, but peritoneal dissemination was evident. Using S-1 against gastric cancer is common. However, S-1 should not be used before another evidence-based curative treatment is available. Furthermore, drugs should have been changed to others, if not effective. A rare clinical course is discussed.     

Two cases of colon cancer after resection of recurrence at peritoneal dissemination were for long-term survival with adjuvant chemotherapy

Generally the peritoneal dissemination of digestive cancer was difficult to control. The symptom of dissemination will decrease quality of life (QOL) for these patients. The diagnosis for the range of dissemination was difficult. Therefore, the decision of the treatment was wavered between an operation and chemotherapy. The effect of chemotherapy was controversial so the cure was inconsistent. We experienced with two recurrent colon cancer patients who underwent resection of peritoneal dissemination and adjuvant chemotherapy. Case 1 was a 62-year-old man. He was operated for left colectomy against descending colon cancer with perforation. After two years, the recurrence of peritoneal dissemination and short bowel obstruction appeared. He was performed short bowel resection and FOLFIRI chemotherapy after surgery. Case 2 was a 72-year-old woman. She was operated on sigmidectomy against sigmoid colon cancer. After three years, the recurrence of peritoneal dissemination at the anastomotic lesion appeared. She was performed low anterior resection (LAR) and S-1 chemotherapy after surgery. But after 3.5 years, the peritoneal dissemination at the anastomotic lesion appeared once more. We decided to have LAR operation and FOLFOX 4 chemotherapy. Both cases maintained a good QOL for a long time. The operation against peritoneal dissemination was one of the good treatments if the range of peritoneal dissemination was clearly restricted.     

Modulation of melanocyte-stimulating hormone receptor expression on normal human melanocytes: evidence for a regulatory role of ultraviolet B, interleukin-1α, interleukin-1β, endothelin-1 and tumour necrosis factor-α

Melanocyte-stimulating hormone (MSH) receptor binding activity and melanocortin-1 receptor (MC1-R) gene expression on normal human melanocytes have been studied as responses to the effects of ultraviolet B (UVB), interleukin-1 (IL-1), endothelin-1 (ET-1) and tumour necrosis factor-α (TNF-α), which are known as UV sensitive regulators of melanocytic function. MSH receptor (MSH-R) binding activity was upregulated by UVB, IL-1α, -1β and ET-1, but was downregulated by TNF-α. Northern blot analysis showed that MC1-R mRNA expression was induced 24 h after UVB irradiation in a dose-dependent manner, and that 24-h treatment with ET-1 also induced an expression of MC1-R mRNA, whereas TNF-α downregulated the expression. In addition, IL-1α and -1β have a small but real inductive effect on MC1-R mRNA expression. Taken together, our results suggest a model in which higher MC1-R mRNA expression is accompanied by upregulation of MSH-R binding activity, and enhanced by UVB or cytokines sensitive to UVB. Such a regulatory system would enable normal human melanocytes to respond to MSH more efficiently and induce an increase of melanization of the skin through the MSH/MSH-R system after UVB radiation.     

Parkinson's disease mortality among male anesthesiologists and internists.

Clusters of Parkinson's disease (PD) among healthcare professionals have been interpreted as evidence of an infectious etiology. Anesthetic gases have also been associated with parkinsonism symptoms and PD among patients undergoing general anesthesia. We investigated PD mortality among large cohorts of male U.S. anesthesiologists (n = 33,040) and internal medicine physicians (n = 33,044). PD mortality for any mention on a death certificate was lower than rates in U.S. men during 1979-1995 for both groups, although anesthesiologists had a significantly elevated risk for PD as underlying cause of death for 10-year follow-up. Direct comparisons of mortality between the two cohorts indicated excess PD mortality in anesthesiologists for >10-year follow-up for any mention and for underlying cause of death. These findings lend some support to the hypothesis that infectious agents or anesthetic gases may be associated etiologically with PD.     

Enteritis necroticans 'pigbel' in a Japanese diabetic adult

Enteritis necroticans 'pigbel' is caused by Clostridium perfringens type C but has rarely been reported in developed countries. A 50-year-old Japanese man with untreated diabetes mellitus (DM) presented with diarrhea and abdominal pain. Intraoperative endoscopic and macroscopic examination disclosed segmental annular mucosal lesions characteristic of clostridial enteritis. Clostridial infection type C was verified on pathological, and immunohistochemical analysis. Although rare, the disease is likely to be underdiagnosed. Hence, the pathology and immunohistochemistry of segmental enteritis with annular mucosal lesions should be examined to establish a diagnosis of enteritis necroticans even in mildly affected patients, and especially those with DM.     

Refractoriness to platelet transfusion following partial hepatectomy for hepatocellular carcinoma: report of two cases

Refractoriness to platelet transfusion indicates a condition in which an expected increase in platelet count is not attained after platelet transfusion. We report herein two cases of refractoriness to platelet transfusion that were caused by the presence of antibodies against the human leukocyte antigen following partial hepatectomy for hepatocellular carcinoma. Due to low postoperative platelet counts in the first case, the patient was transfused with 75 units of platelet concentrate for 3 days after surgery, but was unable to gain a significant increase in the platelet count because of platelet transfusion refractoriness due to anti-human leukocyte antigen antibodies. This case was not complicated and had a favorable clinical course. Despite being transfused with 60 units of platelet concentrate during the 2 days after surgery, the patient's platelet count in the second case did not increase because of the presence of anti-human leukocyte antigen antibodies. Bleeding from the cut surface of the liver into the intraperitoneal cavity was found on the second postoperative day because of a decrease in platelet count. On postoperative day 5, disseminated intravascular coagulation occurred. Perioperative refractoriness to platelet transfusion is an intractable complication since no efficient treatment is available. Preoperative examinations for anti-platelet antibodies should be performed in patients undergoing hepatectomy for hepatocellular carcinoma. This is especially true in cases of decreased platelet counts due to preceding liver cirrhosis and when the prediction for postoperative platelet transfusions is necessary.