[A case of interstitial pneumonitis induced by FOLFIRI+bevacizumab combination therapy for liver and lung metastasis of colon cancer].

A 64 -year-old female received oral S-1 chemotherapy followed by mFOLFOX6 chemotherapy for postoperative liver and lung metastasis of sigmoid colon cancer. The tumor progression was observed after twelve courses of mFOLFOX6 chemotherapy, and then FOLFIRI+bevacizumab chemotherapy was performed. After two courses of FOLFIRI+bevacizumab chemotherapy, leucopenia was observed. The chemotherapy was then discontinued and G-CSF was administered. Two days later she complained of high fever and dry cough, and was admitted to the hospital. A diffuse ground-glass appearance of bilateral lung was observed on chest X-ray and CT. Drug-induced interstitial pneumonitis was suspected, and Pneumocystis carini pneumonia was considered in the differential diagnosis. Oral administration of prednisolone and sulfamethoxazole/trimethoprim did not improve the symptoms, so steroid pulse therapy was performed. Steroid pulse therapy improved respiratory symptoms, but CT findings did not change remarkably. After nine weeks in the hospital, she was discharged with home oxygen therapy. Interstitial pneumonitis induced by FOLFIRI+bevacizumab chemotherapy is rare, but the number of cases may increase with increased use of this regimen. The possibility of interstitial pneumonitis should always be considered when the patient presents with a respiratory disorder while receiving systemic chemotherapy.

[A successfully resected case of liver metastasis of gastrointestinal stromal tumor responding to neoadjuvant chemotherapy with imatinib mesylate and interventional radiology].

A 75-year-old woman underwent resection of gastrointestinal stromal tumor (GIST) of small intestine in 1999. In January 2006, she suffered liver dysfunction and abdominal CT revealed she had a large liver metastasis. At first the tumor in the right lobe progressed to the medial segment and seemed unresectable. She twice underwent transarterial embolization and treatment with 400mg/day of imatinib mesylate. Then percutaneous transhepatic portal embolization was performed. As a result, liver metastasis markedly decreased in size, and extended right lobectomy of the liver was performed in June 2006. A large portion of the liver metastasis showed necrosis, but histopathological examination revealed focal remnants of viable tumor cells. In March 2007, radiofrequency ablation was performed for recurrence of remnant liver. The patient has been treated by imatinib mesylate and is alive with no evidence of tumor recurrence.

Detection of acetazolamide-induced increase in organ blood flow in rabbits by laser flowmetry.

PURPOSE: We investigated the mechanism by which inhibition of carbonic anhydrase (CA) increases organ blood flow. METHODS: Regional blood flow (rBF) in white rabbits anesthetized with ketamine/urethane was measured in the kidney, liver, stomach wall, and abdominal muscle by means of laser blood flow probes. Data obtained from rabbits receiving acetazolamide (AZ) to inhibit CA were compared with those obtained from rabbits ventilated with air containing increased concentrations of CO2. RESULTS: Systolic blood pressure, body temperature, hemoglobin, and base excess were unaffected by either treatment. Inhalation of CO2 increased blood flow in all organs tested as well as the cardiac output and PCO2 but decreased pH. Inhibition of CA by AZ administration increased the rBF only in the liver and kidney and did not increase cardiac output or decrease pH. CONCLUSION: Administration of AZ increased rBF in the tissues and organs that contained large amounts of CA without increasing the cardiac output or decreasing the pH, which suggests a direct local effect. A differential sensitivity to the retention of CO2 is suggested as a possible mechanism of the selectivity of the increase in rBF.