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We report a case of a 76-year-old woman with elevated serum C-reactive protein levels for two weeks after spinal surgery. â¹â¹mTc-labeled white blood cell scan and dual ¹â¸F-sodium-fluoride (¹â¸F-NaF) bone positron emission tomography/computed tomography (PET/CT) were used to detect the site of inflammation. Using non-attenuation corrected images, soft tissue inflammation was detected without metal artifact. Antibiotic treatment attenuated inflammation as seen in an early-phase scan using follow-up ¹â¸F-NaF bone PET/CT. This case demonstrates the role of ¹â¸F-NaF bone PET/CT in the detection of inflammation sites, and can be used to evaluate treatment response in patients with metallic implants.
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PURPOSE: This study assessed the feasibility and compliance of induction chemotherapy with gemcitabine and cisplatin followed by simultaneous integrated boost–intensity modulated radiotherapy (SIB-IMRT) with concurrent gemcitabine in patients with locally advanced unresectable pancreatic cancer. MATERIALS AND METHODS: In this trial, patients received induction chemotherapy consisting of gemcitabine (1,000 mg/m²) and cisplatin (25 mg/m²) on days 1, 8, and 15 of each treatment cycle. Patients were subsequently treated with gemcitabine (300 mg/m²/wk) during SIB-IMRT. The patients received total doses of 55 and 44 Gy in 22 fractions to planning target volume 1 and 2, respectively. As an ancillary study, digital polymerase chain reaction was performed to screen for the seven most common mutations in codons 12 and 13 of the KRAS oncogene of circulating cell free DNA (cfDNA). RESULTS: Forty-four patients were enrolled between 2012 and 2015. Of these, 33 (75%) completed the treatment. The most common toxicities during induction chemotherapy were grades 3 and 4 neutropenia (18.2%), grade 3 nausea (6.8%) and vomiting (6.8%). The most common toxicities during SIB-IMRT were grade 3 neutropenia (24.2%) and grade 3 anemia (12.1%). Ten patients (23%) underwent a curative resection after therapy. Median overall survival was significantly longer in patients who underwent curative resection (16.8 months vs. 11 months, p < 0.01). The median cfDNA concentration was significantly lower after treatment (108.5 ng/mL vs. 18.4 ng/mL, p < 0.001). CONCLUSION: Induction chemotherapy with gemcitabine and cisplatin followed by concurrent SIB-IMRT was well tolerated and active.
Assuntos
Humanos , Anemia , Cisplatino , Códon , Complacência (Medida de Distensibilidade) , DNA , Estudos de Viabilidade , Quimioterapia de Indução , Náusea , Neutropenia , Oncogenes , Neoplasias Pancreáticas , Reação em Cadeia da Polimerase , Radioterapia , VômitoRESUMO
Phlegmonous gastritis is a rare and rapidly progressive bacterial infection of the stomach wall, with a high mortality rate. Antibiotics with or without surgical treatment are required for treatment. We present a case in which phlegmonous gastritis occurred during the diagnostic evaluation of early gastric cancer. The patient showed improvement after antibiotic treatment, but attempted endoscopic submucosal dissection failed because of submucosal pus. We immediately applied argon plasma coagulation since surgical resection was also considered a high-risk procedure because of the submucosal pus and multiple comorbidities. However, there was local recurrence two years later, and the patient underwent subtotal gastrectomy with lymph node dissection. Considering the risk of incomplete treatment immediately after recovery from phlegmonous gastritis and that recurrent disease can be more difficult to manage, delaying treatment and evaluation until after complete recovery of PG might be a better option in this particular clinical situation.
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Humanos , Antibacterianos , Coagulação com Plasma de Argônio , Infecções Bacterianas , Celulite (Flegmão) , Comorbidade , Gastrectomia , Gastrite , Excisão de Linfonodo , Mortalidade , Recidiva , Estômago , Neoplasias Gástricas , SupuraçãoRESUMO
BACKGROUND/AIMS: The lesions of Behcet's colitis showed aphthoid or punched-out ulceration, but the macroscopic types of lesions have not been defined. The aim of this study was to predict the clinical outcome of patients with Behcets colitis according to colonoscopic findings. METHODS: We retrospectively reviewed the medical records and colonoscopic photographs of 50 patients with Behcet's colitis. Colonoscopic findings were categorized according to three types: volcano-, geographic- and aphthous-type. The efficacy of medical treatment was assessed by follow-up colonoscopy or double-contrast barium enema 4 to 8 weeks after treatment and recurrence of the lesions was evaluated during the follow-up period. Cumulative operation rates were obtained by the Kaplan-Meier method. RESULTS: Macroscopic types of colonic ulcers revealed 25 out of 50 (50%) patients with volcano-type, 11 (22%) with geographic-type, and 14 (28%) with aphthous-type lesions. Complete remission rates by medical treatment and operation rates in volcano-type ulcerations were 6 of 25 (24%) and 13 of 25 (52%), geographic-type 8 of 11 (73%) and 1 of ll (9%), and aphthous-type 9 of 14 (64%) and 2 of 14 (14%), respectively. The recurrence rate in volcano-type ulcerations was 9 of 19 (47%), geographic-type 1 of 9 (11%) and aphthous-type 1 of 11 (9%), CONCLUSIONS: Volcano-type ulcerations in Behcets colitis showed less favorable response to medical treatment and more episodes of operation and recurrence than geographic- and aphthous-type ulcerations.
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Humanos , Bário , Classificação , Colite , Colo , Colonoscopia , Enema , Seguimentos , Prontuários Médicos , Recidiva , Estudos Retrospectivos , ÚlceraRESUMO
Hemoptysis occurs quite frequently as a consequence of mitral stenosis, but massive, lirE threatening pulmonary hemorrhage is distinctly unusual. We report a 30 year old female who underwent cmcrgcncy rcdo double valve replacement for intractable pulmonary hemorrhage. she underwent mitral valve replacement (lonescu Shirley 27 mm) due to rheumatic valvular heart disease in 1984 and tricuspid valve annuloplasty (Carpentier's ring 30mm) two years later She was admitted for massive hcmoptysis and dyspnea on the 26th of December, 1995. Medical treatment including transarterial embolization was given but was not satisfactory. Emergency valve replacement (Mitral valve, St. Judc 29mm and tricuspid valve ; St. Jude 33mm) was performed and hemoptysis was controlled dramatically 24 hours after surgery.
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Adulto , Feminino , Humanos , Dispneia , Emergências , Doenças das Valvas Cardíacas , Hemoptise , Hemorragia , Valva Mitral , Estenose da Valva Mitral , Valva TricúspideRESUMO
No abstract available.
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Animais , Camundongos , Ratos , Etanol , Células Matadoras NaturaisRESUMO
We carried out coronary artery bypass grafting using saphenous vein on 8 patients from May, 1987 through January, 1988 at Hanyang University Hospital in Seoul. There were 4 men and 4 women and the mean age was 58.3 years. Except for 1 patient, they were all diagnosed as unstable angina not responding to medical therapy. The average ejection fraction was 66.9%, and no operative death was found. Two sequential anastomoses were performed in one patient. There was no significant event to influence adversely on postoperative prognosis. During the mean follow up period of 6.3 months, none of the patients experienced new symptoms and all of them remain relatively well off the medications used pre and perioperatively execpt for aspirin and persantin.