[Combination therapy with 5'-DFUR, MMC and CDDP in patient with far advanced gastric cancer: report of a case].

A 48-year-old man was referred to our hospital for a Borrmann 3 type advanced gastric cancer. Endoscopic biopsy disclosed poorly differentiated adenocarcinoma. Ultrasonography and CT scan revealed left hydronephrosis. Endoscopic retrograde cholangiography detected a stenosis of common bile duct at the hepatic hilum due to lymph nodal metastasis, and laparoscopy revealed peritoneal dissemination. Because the tumor was diagnosed as not for curative resection, the patient was treated by 4 courses of combination therapy with 5'-DFUR, MMC and CDDP. No adverse effect of chemotherapy was observed. As a result, lymph nodal metastasis and peritoneal dissemination were reduced. Curative intent total gastrectomy was performed, together with pancreatico-splenectomy, left hemicolectomy, cholecystectomy, and extended lymph nodal dissection. The patient is well and alive with no sign of recurrence 2 years after operation.

Effect of tamoxifen on 1,2-dimethylhydrazine-HCl-induced colon carcinogenesis in rats.

BACKGROUND: Evidence suggests that steroid hormones may affect the natural history of colon cancer. METHODS: Baseline levels of estrogen receptors, polyamines, and ornithine decarboxylase in colonic mucosa, and blood estradiol were measured in 10 normal Sprague-Dawley outbread female rats. Therefore, 151 rats were fed a 15% fat diet and divided into three groups. Rats in the control group (n = 20) received weekly s.c injections of the 1,2-Dimethylhydrazine-HCl (DMH) vehicle. To induce colon cancer, 131 rats received weekly subcutaneous injections of DMH (20 mg/kg). Of these 131 rats, 65 also ingested 0.5 microgram/g tamoxifen, daily. Half of the rats in each group were sacrificed at 14 weeks, the remainder at 28 weeks. All measurements were repeated at these times and tumor incidence was calculated. RESULTS: The number of rats with tumors was 41% higher (P = .07) in rats treated with DMH vs those treated with tamoxifen and DMH (72.7% vs 51.5%). Tumor cells in both groups had higher levels of polyamines and ornithine decarboxylase activities (P = .03 to P < .001) and lower levels of estrogen receptors (P = .005) to P < .001) compared to adjacent normal colonic mucosa. Estrogen receptors were not detected in the colons of the rats in the control group. No correlations were found between estradiol and estrogen receptors in normal (r = .01, P = .95) or tumor (r = .03, P = .86) cells, or between polyamines or ornithine decarboxylase and estrogen receptors in normal (r = .01 to .14, P = .63 to .95) or tumor (r = .07 to .26, P = .16 to .86) cells. CONCLUSIONS: Tamoxifen reduced the incidence of DMH-induced colon cancer in rats and may thus have chemopreventive effects. Although it was not statistically significant, further studies are justified to continue this line of research.

The effect of tamoxifen on established human colorectal cancer cell lines in vitro.

UNLABELLED: The purpose of this study was to evaluate the effect of the anti-estrogenic tamoxifen (Tx) on the growth of human colorectal cancer cells. METHODS: Serial concentrations (0.005 microM, 0.05 microM, 0.5 microM, 5 microM, and 50 microM) of the anti-estrogenic tamoxifen (Tx) were added and analyzed for their effect on the growth of established human colorectal cancer cells. HT-29 and SW-620 colon cancer cells and SW-1463 rectal cancer cells were tested in both serum-free media and serum-containing media (10% fetal calf serum). COLO-205 colon cancer and SW-837 rectal cancer cells were only tested in 10% fetal calf serum-containing media. Cell growth was measured with the hexosaminidase assay and was compared among the different groups. Cells were analyzed for estrogen receptors using enzyme immunoassay. RESULTS: In serum-free media, Tx inhibited the growth of HT-29 (P = .05) and SW-620 (P = .01) colon cancer cells at all concentrations tested. RESULTS: In serum-containing media, Tx inhibited (P = .04) the growth of the SW-837 rectal cancer cells at all concentrations and SW-1463 (P = .05) rectal cancer cells at the concentrations of 0.05 microM and 0.5 microM Tx. The inhibition of cell growth in HT-29, SW-620 and SW-1463 line was greater (P < .001) under serum-free media conditions. Estrogen receptors were not detected in any of the cell lines tested. CONCLUSIONS: Hormonal manipulation with colo-rectal cancers is possible, but the effect of Tx on the growth of colon cancer cells differs from the effect on rectal cancer cells under various conditions. The mechanism of inhibition is not clear yet, and further studies are warranted before any clinical implications can be postulated.

Use of laparoscopic techniques in oncologic right colectomy in a canine model.

BACKGROUND: The purpose of this study was to evaluate the feasibility of laparoscopic oncologic righ colectomy (RC) with intraperitoneal ileocolic anastomosis (ICA) in a canine model. METHODS: In 21 dogs a laparoscopic RC with transection of the main right colic artery and removal of adjacent lymph nodes (LN) was carried out using an Nd:YAG contact laser and endoscopic stapler. Two weeks after surgery, all animals were killed. The number of remaining right colon mesenteric LN, length of remaining right colic artery, bursting pressure (BP) of ICA, and postoperative morbidity were evaluated. RESULTS: No major intraoperative complications were recorded. One dog died of pneumonia and heartworms. There were no postoperative septic or anastomotic complications. All dogs passed feces within the first 24 h postoperatively. Median operative time was 135 min (range 105-180 min). Length of remaining right colic artery after oncologic resection was 4.5 mm (range 3-7 mm), the number of remaining LN was 0, and the median anastomotic BP was 232 mm Hg (range 132-312 mm Hg). CONCLUSION: Oncologic resection of the right colon with high vascular ligation, wide mesenteric clearance of LN, and intraperitoneal anastomosis is feasible and safe in a canine model.

Monopolar electrosurgery and Nd:YAG Contact Laser in laparoscopic intestinal surgery.

In a prospective randomized study using a canine model, we compared the use of monopolar electrosurgery (EC) (n = 23) and the Nd:YAG Contact Laser (CL) (n = 21) on intra- and postoperative morbidity in laparoscopic large-bowel resection. In EC, cutting was performed with scissors and coagulation was performed with electrosurgery. In CL, cutting and coagulation were carried out with the Nd:YAG Contact Laser. Laparoscopic oncologic right colectomy with intraperitoneal ileocolic stapled anastomosis was performed in all dogs. Intraoperative smoke development, difficulty of dissection, hemostasis, and postoperative adhesions were judged using a five-point score. Two weeks after surgery, all dogs were sacrificed and zoopsy was carried out. Three dogs died postoperatively from pneumonia and one from an anastomotic leak. There were no other postoperative complications. Operative time was 135 min (range 105-180) in the CL group and 145 min (range 60-210) in the EC group. Intraoperative smoke development, difficulty of dissection, and postoperative amount of adhesions were not different between groups (P > 0.05). Hemostasis in the CL group (median score of 1, range 1-2) was significantly better (P = 0.01) than in the EC group (median score of 2, range 1-5). Scissors and electrosurgery as well as Nd:YAG Contact Laser can be used successfully in intestinal laparoscopic surgery. Although the use of the Contact Laser did not cause less postoperative morbidity than the conventional method, there was significantly better hemostasis using the Nd: YAG Contact Laser.

Laparoscopic oncologic total abdominal colectomy with intraperitoneal stapled anastomosis in a canine model.

The purpose of this study was to evaluate the feasibility of performing an oncologic type of colectomy using laparoscopic techniques with intraperitoneal stapled ileorectal anastomosis in a canine model. In 21 dogs, laparoscopic oncologic colectomy was carried out using dissection with a contact Nd:YAG laser. The right, middle colic, and inferior mesenteric arteries were transected close to their origins, and all adjacent mesenteric lymph nodes were removed. Ileorectal anastomosis was performed using a circular end-to-end stapler especially designed for laparoscopic surgery. Two weeks after surgery, all animals were killed. The number of remaining mesenteric lymph nodes, bursting pressure of ileorectal anastomosis, and postoperative morbidity were evaluated. No major intraoperative complications were recorded. One dog died postoperatively from an anastomotic leak. All dogs passed feces in the first 24 postoperative hours. Median operative time was 145 min (90-240 min). The number of remaining colonic mesenteric lymph nodes was 0, and median anastomotic bursting pressure was 325 mm Hg (183-415 mm Hg). The median distance from ileocolic anastomosis to anal verge was 8.5 cm (6.0-11.0 cm). Laparoscopic oncologic colectomy with wide mesenteric clearance of lymph nodes and intraperitoneal stapled ileorectal anastomosis is feasible and safe in a canine model.

Enterocolitis due to methicillin-resistant Staphylococcus aureus--report of two cases.

Two cases of postoperative enterocolitis due to methicillin-resistant Staphylococcus aureus (MRSA) after gastrectomy were experienced. Case 1: A 59-year-old male underwent subtotal gastrectomy for advanced gastric cancer. Diffuse peritonitis progressed after the first operation, so reoperation for drainage was required. Two days after the second operation, a profuse watery diarrhea developed. Case 2: A 46-year-old male underwent total gastrectomy for early gastric cancer. On the fourth postoperative day, frequent vomiting and cholera-like diarrhea started, followed by profound shock several hours later. Both cases were treated successfully by the administration of vancomycin. Stool cultures of both cases revealed MRSA and it had the same minimal inhibitory concentration, coagulase type and enterotoxin type, so that nosocomial infection was indicated.

Resection and double ileostomy as an alternative approach for superior mesenteric venous thrombosis in poor risk patients: a case report.

An 85-year-old male with a sudden onset of abdominal pain was operated on under the suspicion of intestinal ischemia and was later diagnosed as acute superior mesenteric venous thrombosis (SMVT). The patient was successfully treated by resecting the entire involved bowel and performing a double ileostomy. These procedures are considered to be the preferred method of choice for improving survival in poor risk patients.