ABSTRACT
We encountered a case of hypercobalaminemia induced by oral intake of an energy drink after total gastrectomy. The patient was referred to our hospital due to findings suspicious for gastric cancer on screening. A 20 mm type 0-IIc lesion was detected in the gastric subcardia on esophagogastroduodenoscopy. Total gastrectomy followed by Roux-en-Y reconstruction was performed. He was discharged without complications. His basal serum vitamin B<sub>12</sub> level was initially maintained with monthly intramuscular injections of vitamin B<sub>12</sub>. After 9 months, his serum vitamin B<sub>12</sub> level suddenly increased up to 36-fold higher than the normal range and persisted there for one year without vitamin B<sub>12</sub> injections. The patient ultimately reported consuming half a bottle of an energy drink each day during this time period. This case demonstrates the risk of unexpected hypervitaminemia resulting from self-administration of nutritional supplements.
ABSTRACT
Introduction: A clinicopathological study of diagnosis and treatment for esophageal cancer in Hiraka General Hospital was performed.Patients and Methods: We retrospectively analyzed clinical records of 417 esophageal cancer patients treated between January 1998 through December 2009.Results: It was presumed that we took care of about 10% of esophageal cancer patients in Akita prefecture. Sixty-six percent of the patients were referred to our hospital from other medical facilities during the period under review. On the other hand, those patients with esophageal cancer detected by medical examination or health screening accounted for only 9.6%. The rate of those patients who could receive definitive therapies was 75% (313 cases), and 308 cases (98%) underwent curative surgical resection in Hiraka General Hospital. Among the patients who had received therapy aimed for complete cure, 285 patient (91.1%), went through treatment as planned, and the complete response rate was 73%. Five-year survival rates of all the patients in stage 0, stage I, stage II, stage III and stage IV were 44.7%, 76.3%, 67.3%, 38.0%, 31.6% and 15.6%, respectively. These survival rates are never be inferior to those of major centers for esophageal cancer in Japan. Long term survival rates of the patients who had been diagnosed with esophageal cancer by medical examination or health screening were statistically significantly better than those of the patients who were diagonosed by another categories. Among the 209 patients who responded completely to definitive therapy, the cancer recurred in 50 patients (23.9%). Among the 50 recurrent group, recurrence has been primarily recognized in 33 patients (67%) with in 12 months after definitive therapy and in 40 patients (82%) within 24 months. Therefore, a close follow-up is very important up to 24 months after treatment. As for the cause of death in patients who underwent curative resection the death from esophageal cancer accounted for 66% whereas the death from other diseasea and/or other type of cancer accounted for 34%.