Impact of chemotherapy on eosinophilia-associated advanced rectal cancer: A case report and review of the literature.

The present study reports a case of eosinophilia-associated rectal cancer that was successfully stabilized using chemotherapy, and reviews the mechanisms of eosinophilia and the importance of chemotherapy. A 65-year-old man, who had previously been diagnosed with suspected rectal cancer, presented with the chief complaint of melena. Eosinophilia, abnormal blood coagulation, and elevated carcinoembryonic antigen and carbohydrate antigen 19-9 tumor marker levels were observed, and the patient was subsequently diagnosed with advanced rectal cancer accompanied by multiple lymph node metastases that extended from the para-aortic lymph nodes to the left axillary lymph nodes. The complication of deep vein thrombosis was also observed. Tumor hemorrhage was exacerbated, and thus, Hartmann's procedure was performed. Pathological findings included poorly- to moderately-differentiated adenocarcinoma; however, no eosinophil infiltration was observed within the tumor. Following surgery, the eosinophilia and lymph node metastasis were exacerbated, and an oxaliplatin plus capecitabine chemotherapy regimen was initiated. The patient's eosinophil count and tumor marker levels normalized, and the lymph nodes decreased in size; however, re-enlargement of the lymph nodes was observed 6 months after surgery. The patient was then administered a chemotherapeutic regimen of irinotecan/fluorouracil/folinic acid + bevacizumab, and stable disease was maintained until pleural and peritoneal dissemination were observed at 22 months post-surgery. Following a rapid deterioration in condition, the patient succumbed to the disease at 23 months post-surgery. The present case indicates that although eosinophilia-associated colon cancer exhibits a poor prognosis, early chemotherapeutic intervention may improve this.

Middle-preserving pancreatectomy with reversed pancreaticogastrostomy: report of a case.

Parenchyma-sparing pancreatic resections have been reported increasingly in recent years; however, for multifocal diseases involving the head and the tail of the pancreas, total pancreatectomy is still the preferred procedure. The possible consequence of this procedure is loss of normal pancreatic parenchyma, resulting in insufficiency of pancreatic exocrine and endocrine functions. Various types of limited resection have been introduced for isolated or multiple pancreatic lesions, depending on the location of the tumor. Even for multifocal diseases, if the pancreatic body is spared, a middle-preserving pancreatectomy (MPP) can be performed to assure maximal pancreatic function and uncompromised quality of life. Yet, few papers have introduced the feasibility of MPP for a better outcome. This report describes a new surgical technique for MPP using an alternative approach for the remnant pancreas anastomosis. We used this technique successfully to remove a bifocal neoplasm: adenocarcinoma of the distal bile duct and mucinous cyst adenoma in the tail of the pancreas.

Enhanced multidetector-row computed tomography (MDCT) in the diagnosis of acute appendicitis and its severity.

PURPOSE: To examine the accuracy of enhanced multidetector-row computed tomography (MDCT) in diagnosing acute appendicitis and its severity. MATERIALS AND METHODS: Contrast-enhanced MD-CT 3.5 mm thick images of 23 control patients (A), and 64 patients with surgically proven acute appendicitis including 8 catarrhal (B), 28 phlegmonous (C), and 28 gangrenous (D) appendicitis patients were respectively analyzed. RESULTS: The number of observed major computed tomography (CT) findings for each patient group were as follows: enlarged (> or = 6 mm in maximum diameter) appendix (A: 5, B: 8, C: 28, D: 28), enhancement of the appendiceal wall; hyper (A: 3, B: 8, C: 27, D: 20), iso (A: 15, B: 0, C: 1, D: 2), hypo (A-C: 0, D: 4), and patched (A-C: 0, D: 2) enhancement, appendicolith (A, B: 0, C: 7, D: 13), dirty fat sign (A: 3, B: 1, C: 21, D: 28), localized ascites (A: 2, B: 0, C: 2, D: 11), and abscess formation (A-C: 0, D: 5). From the combinations of these findings, we could differentiate acute appendicitis from the control normal appendix with an accuracy of 99% and could diagnose the severity of acute appendicitis with accuracies of 92% for catarrhal appendicitis, 84% for phlegmonous appendicitis, and 92% for gangrenous appendicitis. We could also visually reconstruct the entire forms and positions of the appendices from the successive CT findings because of the high-resolution thin-slice MDCT images. CONCLUSION: MDCT is highly accurate in the diagnosis of acute appendicitis and its severity.