ABSTRACT
A 78-year-old man was diagnosed with adult T-cell leukemia/lymphoma (ATL) and was started on standard chemotherapy 1 year earlier. However, treatment was discontinued because of adverse drug reactions and worsening delirium. Thereafter, he remained stable and was followed up while receiving etoposide. He then visited our hospital because of acute abdominal pain and underwent surgery with a diagnosis of gastrointestinal perforation. Intraoperative observation showed a reddened, concentric wall thickening measuring 4 cm and a perforation site in the ileum, and thus partial resection of the small bowel was performed. The histological diagnosis was small bowel perforation due to tumor cell invasion. Two months postoperatively, he started a less intensive chemotherapy regimen along with palliative care, and died due to the primary disease approximately 5 months postoperatively. ATL involves systemic organs because of its high organ-affinity. Once it involves the gastrointestinal tract, various gastrointestinal symptoms can occur. Patients with ATL are at risk of developing gastrointestinal perforation at any time during the clinical course. Therefore, clinicians should be aware that once gastrointestinal perforation develops, the prognosis becomes extremely poor. Assessment of the disease state, early detection of gastrointestinal lesions, and prevention of opportunistic infections appear to be important in the management of patients with ATL.
ABSTRACT
Pancreatic neuroendocrine tumors, relatively rare cancers, mostly arise in the pancreatic parenchyma with infrequent involvement of the main pancreatic duct. Now and then, however, case reports have been published on pancreatic neuroendocrine carcinoma in which the main pancreatic duct is obstructed by tumor cells with severely fibrous stromal cells. Here, in this paper, we report a case of pancreatic neuroendocrine carcinoma with obstruction of the main pancreatic duct. A 59-year-old man complained of right upper abdominal pain. Magnetic resonance cholangiopancreatography and fat-suppressed T1-weighted magnetic resonance imaging showed gallbladder stones, a low-intensity-area measuring 8 mm in diameter in the pancreatic body, and club-shaped dilatation at the distal end of the pancreatic duct. The patient was thus diagnosed with a tumor in the pancreatic body and cholecystolithiasis, and underwent distal pancreatectomy and cholecystectomy. HE-staining showed tumor cells with eosinophilic cytoplasm and nuclear atypia. The infiltrative growth of the cells with severe fibrosis caused stenosis of the pancreatic duct. Based on the positive results of immunohistochemical staining for chromogranin A and synaptophysin and the Ki-67 index, the tumor was finally identified as pancreatic neuroendocrine carcinoma. The patient has been under follow-up with no additional treatment for >3 years since the surgery, without evidence of tumor recurrence.
ABSTRACT
Among visceral artery aneurysms, those arising in the region of the pancreatic duodenal artery due to celiac artery stenosis are rare. We report a surgical case with stenosis caused by dissecting celiac artery aneurysms and multiple aortic aneurysm rupture in the pancreaticoduodenal region. A 72-year-old man with a history of distal gastrectomy for gastric cancer was carried into our hospital by ambulance for acute abdominal pain. CT scans showed dissected aneurysms of the root of the celiac artery and hepatic artery as well as massive retroperitoneal hematoma around the pancreaticoduodenum and intraperitoneal hemorrhage. Arteriography of the superior mesenteric artery revealed multiple aneurysms of the pancreaticoduodenal artery that might have caused rupture. In the late phase, retrograde flows in the gastroduodenal, hepatic, celiac, and splenic arteries from the pancreaticoduodenal artery were contrast-enhanced. Because it was thought that transcatheter arterial embolization or surgical aneurysmectomy for pancreaticoduodenal aneurysms could prevent blood flow in all circulating branch arteries of the celiac artery, leading to extensive organ ischemia, the gastric pouch, spleen, entire pancreas, and gallbladder were resected. The patient has been doing well.
ABSTRACT
<b>Objective: </b>The present study investigated awareness and knowledge about clinical trials among pharmacists working in the Nagano Hokushin area as well as their contribution to the enlightenment of clinical trial.<br><b>Methods: </b>A questionnaire survey of clinical trials was conducted to evaluate levels of interest, impressions, sources of information, and knowledge among hospital and community pharmacists.<br><b>Results: </b>We received responses from 77 hospital and 67 community pharmacists. The levels of interest in clinical trials were not significantly different between hospital and community pharmacists. About impressions, hospital pharmacists thought that clinical trials were “a new development.” Contrarily, community pharmacists thought that clinical trials were “a field that they were seldom concerned with.” About sources of information, hospital pharmacists found that “study meetings” were the most informative. More community pharmacists than hospital pharmacists chose “general reports, for example, newspapers and televisions” as a source of information, and similarly more community pharmacists indicated that they had “few opportunities for obtaining information about clinical trials.” About knowledge, the percentage of correct answers about clinical trials between hospital and community pharmacists was not significantly different. A higher percentage of community pharmacists than hospital pharmacists answered unknown.<br><b>Conclusion: </b>Hospital and community pharmacists had different impressions and knowledge about clinical trials probably because of differences in sources of information and its access. Henceforth, study meetings involving educational material about clinical trials should be held for discussing fundamental knowledge about the methods and structure of clinical trials and for discussing case studies wherein patients consult pharmacists about clinical trials.