Spontaneous perforation of the rectum with possible stercoral etiology: report of a case and review of the literature.

Stercoral perforation of the colon or rectum is a rare cause of acute abdomen, with fewer than 70 cases documented in the literature. We report herein the case of a 60-year-old man who presented with anuria and epigastric pain with physical signs of peritonitis. An abdominal X-ray showed bilateral subphrenic free air accumulation, and an emergency laparotomy subsequently revealed perforation of the rectum, suggestive of a stercoral cause, which was treated by simple closure after debridement. Following an uneventful postoperative course, he was discharged from the hospital 3 weeks after his operation and is now doing well without having suffered any further gastrointestinal problems. The clinical features, diagnosis, and treatment of the disease are reviewed following the presentation of this case. Surgeons should be aware of the possibility of this fatal disease, despite its rare incidence. Furthermore, it is important to recognize the condition at an early stage because it has a significantly high mortality if not treated early. Conversely, the surgical outcome is satisfactory provided surgery is performed in due time.

Postsurgical sequential methotrexate, fluorouracil, and leucovorin for advanced colorectal carcinoma: a preliminary study.

BACKGROUND AND OBJECTIVES: The present study compared the effects of sequential methotrexate and fluorouracil followed by leucovorin rescue (MFL), as an adjuvant chemotherapy versus a combination of tegafur (UFT) and mitomycin C (MMC), on patient survival and recurrence after surgery for colorectal carcinoma. METHODS: Between January 1990 and December 1995, a total of 46 patients with advanced colorectal cancer were treated postsurgically by adjuvant chemotherapy using MFL or UFT-MMC. Surgical treatment was performed according to standardized procedures for radical resection of colorectal cancer. The patients were stratified into two groups after surgery. The MFL regimen consisted of MTX (100 mg/m2) and 5-FU (600 mg/m2) at hour 24, followed by leucovorin rescue. The UFT-MMC regimen consisted of MMC (12 mg/m2) intraoperatively and MMC (6 mg/m2) ever other week after surgery for 2 months and oral UFT (375 mg/m2/day), a combination of tegafur and uracil in a molar ratio of 1:4, was continued for 3 years or longer depending on the patients tolerance. RESULTS: The overall survival rates after surgery was significantly (P < 0.05) higher in the MFL than the UFT-MMC group. Recurrence rates were significantly lower in the MFL than the UFT-MMC Group, especially for liver recurrence. Disease-free survival was significantly (P < 0.05) higher in the MFL than the UFT-MMC group. CONCLUSIONS: The present results demonstrated the superiority of MFL therapy for improving postsurgical survival in patients with advanced colorectal cancer, in particular for those patients with a high risk of recurrence following potential curative resection.

[Occurrence of choroidal neovascularization following photocoagulation treatment for central serous retinopathy].

Occurrence of choroidal neovascularization following laser photocoagulation treatment for central serous retinopathy (CSR) has been reported. We reviewed all the cases of photocoagulation treatment for CSR in our clinic during the past 25 years (1968-1993). Among 1,824 CSR-affected eyes which were treated, choroidal neovascularization occurred in 19 at the site of photocoagulation. In a careful reevaluation of pretreatment fluorescein angiograms, small choroidal neovascularizations were detected in 5 eyes, in which cases the diagnosis of CSR was incorrect. In 3 eyes, choroidal neovascularization was suspected and might have been masked. In the remaining 11 eyes, choroidal neovascularization was not seen. Our survey indicates that, in central serous retinopathy, when the age of the patient is over 50 years, and leakage is weak and parafoveal, choroidal neovascularization may be masked. Laser photocoagulation for these eyes should be conservative with careful, long-term observation.

[Leiomyosarcoma of ileocecal mesentery--a case report].

We report a case of leiomyosarcoma whose origin was near the root of ileocecal mesentery and extended into the retroperitoneum. Preoperative imaging examination, including CT, MRI and angiography clearly displayed its origin and retroperitoneal extension. These results contributed to treatment planning.

[Pharmacokinetics and clinical results of cefuroxime (CXM) (author's transl)].

I. Pharmacokinetics (1) CXM 24.4 and 31.9 mg/kg were administered by intravenous drip infusion for 4 hours. The plateau levels were obtained at 1 approximately 2 hours, the blood levels at which time were 25.6 and 33.8 micrograms/ml respectively with dose response observed. (2) The respective half-lives were as short as 49.4 and 36.2 minutes. (3) The total clearances were 74.6 and 127.2 ml/min respectively; when calculated on plateau level and infusion rate, these were 81.6 and 111.0 ml/min. These differently determined values were near each other. (4) The respective renal clearances were 157.8 and 101.9 ml/min. II. Clinical results CXM for intravenous use was administered to 21 pediatric patients, and the clinical results were good and excellent in 19 (90.5%). Excluding 2 cases with elevation of cold hemagglutination values, the efficacy rate of 94.7% (18/19 cases) was achieved. The doses administered ranged 44 approximately 100 mg/kg body weight, and this dosage level was considered enough to achieve clinical effect. With the current clinical trial we considered that although the effectiveness of this drug was proved in 3 approximately 7 day intravenous drip infusion and intravenous injection, the continued treatment with other oral antibiotic following CXM treatment would be necessary from the patients' general conditions and laboratory examination findings. No noteworthy side effects were observed in any of the patients. No abnormality was seen in biochemistry and electrolyte findings, either.

[Pharmacokinetics and results of clinical administration of CS-1170. I. Pharmacokinetics of CS-1170 (author's transl)].

(1) When 20.8 approximately 34.7 mg/kg body weight of CS-1170 were instilled intravenously for 30 minutes to one hour, peak levels were obtained on completion of the intravenous drip in the range 85.7 approximately 1,117.3 microgram/ml. (2) The half life was 22 approximately 49 minutes which is very rapid. (3) The kidney clearance was 6.8 approximately 104.8 ml/min. (4) The total clearance was 5.9 approximately 111.5 ml/min, showing correlation with the kidney clearance. (5) The apparent distributional capacity was 0.3 approximately 4.3 liters, showing a strong correlation with body weight.

[Pharmacokinetics and results of clinical administration of CS-1170. II. Results of clinical administration of CS-1170 (author's transl)].

The intravenous preparation of CS-1170 was administered in 9 cases of pediatric disease and was excellent or good in 5 cases (55.6%). It was poor in 3 of 4 cases of Mycoplasma pneumonia. We think that the dose of 50 mg/kg/day can exert an effect regardless of the intensity of symptoms. Through our present experiences with the excellent or good cases, an intravenous drip or intratracheal injection for 3 approximately 5 days is effective. Although there was no abnormality in the biochemistry or electrolyte findings before or after administration, eruption developed in one of the cases in which the drug was administered for 6 days.

Down syndrome with trisomy in one triplet.

The case presented here may be the first identified report of Down syndrome with 21 trisomy in one child of triplets. One triplet died at 1 month of age; his facial appearance was not typical of Down syndrome. Detailed testing of blood groups suggested identical origin in the remaining two children. However, the fluorescent banding technique of chromosome, one-way mixed lymphocyte culture test, and HLA typing were suggestive of dizygotic orgin. Skin transplant studies supported this contention.