Peristomal skin disorders in patients with intestinal and urinary ostomies: influence of adhesive forces of various hydrocolloid wafer skin barriers.

PURPOSE: This study examines the adhesiveness of hydrocolloid wafers and its relationship to physical damage of the underlying skin. DESIGN: Observational study. SUBJECTS AND SETTING: All subjects received ostomy care at the Tokyo Ostomy Center and outpatient departments of 4 hospitals in Tokyo, Japan. One hundred ninety-four of 917 patients receiving care over a 23-year span agreed to participate in the research. Subjects met 2 inclusion criteria: (1) ostomy management was performed using a combination of skin barriers and an adhesive ostomy pouch; and (2) the patient's medical file and color photographs were available, allowing analysis of the peristomal skin over time. INSTRUMENT: Photographs were taken with an Olympus (OM2) camera equipped with an Olympus macro lens and a ring flash. METHODS: We analyzed the impact of the adhesive force of various hydrocolloid wafers on the underlying skin. Photographs were digitized and systematically examined the peristomal skin exposed to regular use of skin barriers. The observation period varied among individual patients, ranging from 1 week to 30 years after surgery. RESULTS: The incidence of dermatologic changes (active, inactive, and area cutanea changes) was lower in patients who used skin barriers with adhesive force of not more than 2 Newtons(N) than among those using higher forces (>2 N). Specifically, there was a significant difference in change of the area cutanea. The incidence of papules and erosion was unrelated to the adhesive force of skin barriers. CONCLUSIONS: These results suggest that the peristomal skin is irritated by repeated peeling, resulting in physical damage to the horny layer of the skin. The presence of papules and erosion was not associated with the adhesive force of skin barriers. This finding suggests that these changes are associated with an inflammatory process, possibly caused by chemical substances within the skin barrier.

Arterial infusion chemotherapy in patient with repeated recurrent tumor of cecal cancer: report of a case.

PURPOSE: We report a patient with a repeated recurrent tumor after Right-hemicolectomy for advanced cecal cancer who was treated by intra-arterial infusions of 5-fluorouracil (5-FU). METHODS: A computed tomography scan revealed a pelvic mass involving the psoas major muscle and quadratos lumborum muscle, in contact with the widely projecting toward L2-S2. The fluorodeoxyglucose-positron emission tomography (FDG-PET) revealed an accumulation spot in the same place. This case was deemed in operable, and one-shot bolus of 5-FU was administered through the tumor feeding arteries: the left 3rd, 4th lumbar, and ilio -- lumbar arteries at a dosage of 250 mg/body from each artery. RESULTS: A partial regression of the tumor was observed by computed tomography. The serum level of carbohydrate antigen 19-9 returned normal in 8 months. During chemotherapy, the side effect and complications were tolerable, and she experienced only grade-1 nausea caused by 5-fluorouracil. CONCLUSION: A long-time, intra-arterial 5-fluorouracil infusion could control effectively and safely.

Poorly differentiated adenocarcinoma of the colon and rectum: clinical characteristics.

BACKGROUND/AIMS: The aims of this study were to assess the prognosis and histopathological factors of poorly differentiated colorectal adenocarcinoma, and the clinical relevance of the proposed histopathological sub classifications. METHODOLOGY: Fifty eight patients with poorly differentiated adenocarcinoma were enrolled in this study. According to the lymphatic canal spread in tumor tissue, they were classified into lymphangitic type (tumor spread beyond the intra mucosal tumor space through the lymphatic canal widely) and non-lymphangitic type (tumor spread within that space). Next, they were sub classified into medullary, intermediate and scirrhous types according to the amount of fibrous stroma. In addition, immunohistological examinations were performed on the expression of an intercellular adhesion molecule (E-cadherin). RESULTS: In 33 cases (57%) Lymphangitic type was present and in 25 cases non-lymphangitic type (43%) was present. In the lymphangitic types, 5 cases were medullary type (15%), 17 cases were intermediate type (52%) and 11 cases were scirrhous type (33%) that included 2 cases of signet ring cell carcinoma. In the non-lymphangitic types, medullary type was dominant (20 cases, 80%) while intermediate type and scirrhous type were 3 cases (12%) and 2 cases (8%), respectively. The survival rates were calculated for both types and a large difference was found in terms of 5-year survival rate; 0% for lymphangitic type and 72% for non-lymphangitic type (p<0.05). There was no correlation found between the expression of cadherin and the subclassification. CONCLUSIONS: In conclusion, a wide tumor infiltration and growth in lymphatic vessels appears to be an important prognostic factor for poorly differentiated adenocarcinoma compared to the metastasis patterns.

Palliative surgical treatment for enterostasis caused by recurrent gastric cancer: analysis of survival and QOL based on pathological features.

To improve quality of life (QOL) and prolong survival, enterostasis caused by recurrent gastric cancer must be treated appropriately. We reviewed the current treatment retrospectively. The subjects were 43 patients with enterostasis caused by recurrent gastric cancer and treated by surgical procedures at our hospital from 1988 to 1997. Survival and QOL were analyzed in relation to the mode of recurrence, the pathological diagnosis at the initial operation, and surgical procedures. The patients treated by colostomy, ileostomy, or bypass for local occlusion caused by isolated peritoneal recurrence or lymph node recurrence had significantly better quality of life and longer survival [discharge rate: colostomy and ileostomy, 81.8% (9/11); bypass, 77.8% (14/18); survival time: colostomy and ileostomy, 223.5 +/- 171.9 days; bypass, 129.6 +/- 91.0 days] than those who underwent exploratory laparotomy, gastrostomy, or enterostomy and had diffuse disseminated lesions of peritoneal recurrence [discharge rate: 21.4% (3/14); survival time: 44.6 +/- 31.5 days; P < 0.05]. In the patients in whom the pathological diagnosis at initial surgery was differentiated type or poorly solid type, the risk of exploratory laparotomy alone was low (5.6%; 1/18; P < 0.01). Enterostasis with pathological diagnosis at initial surgery of differentiated type or poorly solid type should be treated with aggressive laparotomy and colostomy, ileostomy, or bypass to improve survival and QOL.

Cytological and histological diagnoses of recurrent thyroid carcinoma with monoclonal antibody JT-95, which can detect modified fibronectin.

Although fine needle aspiration (FNA) cytology has increasingly gained importance as a tool in thyroid diagnosis over the recent years, up to 20% of thyroid carcinomas, in particular follicular tumors and follicular variant tumors, are inconclusive by FNA. The monoclonal antibody (MoAb) JT-95 detects the modified fibronectin, expressed in most thyroid carcinomas. Consequently, it has been applied to FNA and tissue section specimens obtained from thyroid tumors during surgery. For FNA specimens of 57 thyroid tumors followed-up for more than 10 years postoperatively and stained with both the Papanicolaou and the immunoperoxidase technique using MoAb JT-95, we retrospectively compared the sensitivity, specificity, and diagnostic accuracy of the two procedures. Histological specimens stained with HE and investigated by JT-95 were also re-evaluated. The pathological results of aspirated specimens, after a change in diagnosis following recurrence, revealed that 43 of 47 malignant lesions were positive, while nine of 10 benign tumors remained unreactive using MoAb JT-95. Sensitivity was 91.4%, specificity 90.0%, and diagnostic accuracy 91.2% by JT-95 cytology. By contrast, sensitivity ascertained by the Papanicolaou technique was 78.1%, specificity 100%, and accuracy 82.4%. Of the six examples that recurred during the 10-12-year follow-up period, tissue sections of all six and aspirated materials of five of the six were stained by JT-95.

[Multiple hepatic metastases of colon cancer responding to combined therapy with TS-1 and CPT-11--a case report].

We treated a patient with multiple liver metastases arising from colon cancer in whom the metastatic tumors were responsive to treatment with the combination of TS-1 and CPT-11. The patient was a 71-year-old woman with cancer of the ascending colon and metastatic hepatic tumors. She had undergone surgery on July 28, 2004, and abdominal contrast CT scans obtained after discharge from hospital revealed numerous LDA (low-density areas) in both lobes of the liver. The patient was given ambulatory chemotherapy with TS-1 (120 mg/day on days 1-14) and CPT-11 (100 mg/day on days 1 and 8). After completion of 2 courses of chemotherapy, abdominal contrast CT scans revealed that most of the LDAs in both lobes of the liver had disappeared, and the patient was judged to have achieved PR. No adverse reactions were observed except for a slight decrease of WBC, and her chemotherapy is being continued at present. This case suggests that the combination of TS-1 and CPT-11 may be an effective form of chemotherapy for the treatment of colon cancer with multiple hepatic metastases.

The activities of thymidine phosphorylase and dihydropyrimidine dehydrogenase in colorectal cancer depend on where the sample is taken.

The significance of tumor tissue thymidine phosphorylase (TP) and dihydropyrimidine dehydrogenase (DPD) levels, as well as the TP/DPD ratio have recently been reported as prognostic factors and for custom-made chemotherapy. However, there have been no distinct studies on actual tumor sampling methods. For 16 patients who had undergone resection of advanced colorectal cancer, we: i) measured TP and DPD levels in different portions of the tumor using enzyme-linked immunosorbent assay (ELISA); ii) categorized the tumor into an edge, center, and base area, and histo-pathologically calculated the ratio of cancer cell/cancer cell + stromal cell; and iii) examined the correlation between cancer and stromal cell TP expression and TP value. Variation within the same tumor was seen in each activity level and TP/DPD ratio. The ratio of cancer cell in the edge area was high, with the ratio of stromal cell in the center and base areas increasing in that order. A correlation was seen between TP expression and TP levels, and TP expression was evident in the stromal cells. It is therefore recommended to sample the edge area for tumor TP levels.

Expression of matrix metalloproteinase 7, laminin and type IV collagen-associated liver metastasis in human colorectal cancer: immunohistochemical approach.

BACKGROUND/AIMS: Matrix metalloproteinase 7 (MMP-7) plays an important role in vessel invasion and metastasis in human colorectal cancer. METHODOLOGY: The significance of MMP-7, laminin and type IV collagen expression in human colorectal cancer was investigated by immunohistochemical assay, and the correlation with liver metastasis was analyzed. RESULTS: In a synchronous metastasis group, 26 of 36 cases (72%) showed positive staining of MMP-7: There were 32 cases (89%) in the lymph channel and 28/32 cases (87%) in the vessels, and 17/34 cases (50%) showed a positive rate of laminin. In the metachronous metastasis group, 14 of 30 cases (47%) showed positive staining of MMP-7: There were 19 cases (63%) in the lymph channel and 13/19 cases (69%) in the vessels, and 17/30 cases (57%) showed a positive rate of laminin. In the control group, which was a 5-year disease-free group, despite there being no significant clinicopathological factors compared with the other two groups, 17 of 37 cases (51%) showed positive staining of MMP-7: There were 12 cases (37%) in the lymph channel and 6 cases (18%) in the vessels, and 2/31 cases (5%) showed a positive rate of laminin. The expression of type IV collagen attenuated in 19 out of 32 cases (59%) in Group S, 10 out of 19 cases (53%) in Group M, and 14 out of 37 cases (38%) in Group C, with no significant differences among the groups. Thus, the metastatic groups were significantly higher than the control group in terms of expression of laminin and MMP-7 in the lymph channel. CONCLUSIONS: These findings suggest that laminin and the expression of MMP-7 in the lymph channel is a useful parameter for predicting liver metastasis.

[A case of gastric cancer with abdominal paraaortic lymph node metastases responding to TS-1 plus CDDP neoadjuvant chemotherapy].

A 62-year-old woman was admitted because of epigastralgia and tarry stool. An endoscopic examination revealed type 3 cancer in the lower body of the stomach, and abdominal CT scan demonstrated enlarged abdominal paraaortic lymph nodes. The preoperative diagnosis was cStage IV gastric cancer (cT3, cN3, cH0, cP0, cM0). Since a curative operation was deemed impossible, we started neoadjuvant chemotherapy using TS1 plus cisplatin (CDDP) for downstaging. TS-1 (100 mg/day) was orally administered for 3 weeks, and CDDP (90 mg/body) was administered intravenously on day 8. Appetite loss of grade 3 and leucopenia of grade 1 were observed. After two courses of chemotherapy, the primary lesion was reduced in size, and the paraaortic lymph nodes disappeared on abdominal CT scan. The serum tumor marker became normal. Subsequently, she underwent curative total gastrectomy with splenectomy and lymph node dissection. Histological examination of the primary lesion revealed marked fibrosis and a small amount of residual cancer cells. The histological changes by neoadjuvant chemotherapy were judged to be grade 2 for the main tumor. It is suggested that neoadjuvant chemotherapy using TS-1 plus CDDP is effective for advanced gastric cancer with massive lymph node metastases.

[Home chemotherapy by concomitant UFT + Leucovorin (po.) in postoperative colorectal cancer patients assessed with Dukes D and curability C colorectal cancer].

UNLABELLED: Concomitant treatment with 5-fluorouracil (5-FU) and Leucovorin (LV) is positioned as the standard chemotherapy against colorectal cancer. We noted the action of LV to enhance the effect of biochemical modulation by 5-FU, and made an attempt at home chemotherapy with UFT + LV by oral administration, in consideration to the convenience of patients. SUBJECTS: The subjects of this study were 24 post-operative patients who had been assessed with Dukes D and curability C colorectal cancer with measurable metastatic lesions and who could tolerate chemotherapy. METHODS: 1 course of treatment consisted of 2 weeks of UFT at 300-400 mg/m2/day and LV at 15 mg/body/day followed by 2 weeks of drug withdrawal. The administration was conducted for 4 courses or more as the target. Unless serious adverse reaction occurred, dose increase of UFT was allowed. RESULTS: The efficacy rate in the 22 patients who were assessable was 22.7%. There were 11 NC patients, accounting for half (50%) of the subjects. This home chemotherapy is expected to become an alternative chemotherapy against colorectal cancer in the future, because the treatment does not require hospitalization and has less impact on the QOL of patients.

Circulating alpha-2-macroglobulin levels and depression scores in patients who underwent abdominal cancer surgery.

BACKGROUND: Although depression is a predominant health care problem, it is difficult to diagnose in patients who underwent abdominal cancer surgery. Relevance of elevated levels of serum of alpha-2-macroglobulin (A2M) to psychological depression has been recently suggested. PATIENTS AND METHODS: Serum A2M levels were measured and depression scores were determined by the Hospital Anxiety and Depression Scale before and 1 year after abdominal cancer surgery in 45 patients. RESULTS: Serum levels of A2M and depression scores were significantly (P = 0.0006, P = 0.0045, respectively) increased after total gastrectomy compared with preoperative values, whereas there was no interval change in both measurements of patients having colorectal resection. Of the patients who had undergone distal or total gastrectomy for gastric cancer, serum A2M concentrations in a depressed group were significantly higher (P = 0.028) than those in non-depressed group. CONCLUSIONS: Patients with total gastrectomy are predisposed to depression, and circulating A2M elevation may be implicated in the development of postoperative depression in these patients.

Influence of modest endotoxemia on postoperative antithrombin deficiency and circulating secretory immunoglobulin a levels.

OBJECTIVE: To evaluate the influence of modest endotoxemia on postoperative antithrombin deficiency and cholestasis. SUMMARY BACKGROUND DATA: It has not been determined whether endotoxin translocation in small amounts is a physiological phenomenon or whether it is a potential health hazard. METHODS: Blood endotoxin, antithrombin III (ATIII), secretory immunoglobulin A (sIgA), which was selected as a marker of cholestasis, C-reactive protein (CRP), and alpha-1-antitrypsin (AAT) concentrations were measured from the 20 patients undergoing curative gastrectomy for gastric cancer preoperatively and postoperatively. Portal and systemic blood samples were taken for the analysis of endotoxin and interleukin-6 (IL-6) concentrations during surgery in these patients. RESULTS: Although plasma endotoxin levels showed a significant increase during surgery, we did not find a correlation with ATIII, sIgA, CRP, and IL-6 levels. Systemic blood endotoxin levels during surgery correlated with a postoperative rise of serum AAT levels. Plasma ATIII levels transiently decreased on the first and third postoperative day, and sIgA levels were shown to increase on the seventh postoperative day. There was a weak relationship between the extent of postoperative endotoxemia and a reduction in ATIII concentrations. CONCLUSIONS: The influence of modest endotoxemia on postoperative antithrombin deficiency and cholestasis was limited, and increased translocational endotoxemia during abdominal surgery may be a physiological phenomenon to trigger off an acute-phase protein response.

[A case report of effective chemoradiation with 5'-DFUR and concomitant preoperative radiotherapy of the lower rectum].

We treated a lower rectal carcinoma patient with preoperative radiation and chemotherapy, resulting in a downstaging, and the findings are reported herein. The patient is a 55-year-old woman endoscopically diagnosed with advanced rectal carcinoma at a site 3 cm from the dental line. Preoperative radiation and chemotherapy included whole pelvis irradiation (44 Gy in total) and 800 mg/day of 5'-DFUR administered until one day before the operation. On the 20th day after completing irradiation, a low anterior resection of the rectum was conducted. During the operation, we found serositis of the small intestine and retroperitoneal fibrosis thought to be due to the irradiation. Histopathologic findings showed: invasion degree, sm2; stage I with N0; and histologic grading, Grade 2. The patient started drinking water from postoperative day 1, and was discharged on postoperative day 11. At present, in Europe and the USA, large scale studies are being conducted to evaluate preoperative radiation and chemotherapy in patients with lower rectal carcinoma. We think that this therapy is an effective treatment, since a distance (AW) from the lower margin of the tumor and the cut edge of the anal end can be established.