Preoperative UFT administration for patients with advanced colorectal cancer--increased uptake of 5-fluorouracil by tumor tissue is a prognostic factor.

The aim of this study was to clarify whether increased 5-fluorouracil (5-FU) uptake by tumor tissue following preoperative UFT administration is a prognostic factor after surgery in colorectal cancer patients. We examined the concentrations of 5-FU in tumor or normal tissue of 96 colorectal cancer patients who received UFT (400 mg/day) orally for 7 days prior to surgery. Patients were divided into two groups with high or low 5-FU concentrations in tumor tissue (defined as higher or lower than the cut-off value, respectively). The cut-off value of 5-FU was established based on the upper limit of the 95% confidence interval of the median of the concentration found in normal tissue (0.106 microg/g). Of the 96 patients, 62 (64.6%) were in the low-5-FU group and 34 (35.4%) in the high-5-FU group. The latter had a more favorable clinical outcome (p=0.0465). Cox regression analysis revealed that two independent variables, stage and 5-FU status in tumor tissue, were significant for prediction of survival. These findings suggest that increased uptake of 5-FU by tumor tissue following preoperative oral administration of UFT is an independent prognostic factor in colorectal cancer patients. This variable needs to be considered in the design of future therapeutic trials.

Multicenter randomized prospective study of adjuvant chemotherapy with UFT and mitomycin C in advanced colorectal cancer.

BACKGROUND: A randomized prospective trial was performed to determine the efficacy of preoperative and postoperative adjuvant oral UFT, administered with mitomycin C (MMC) after resection for advanced colorectal cancer. MATERIALS AND METHODS: A total of 126 patients were entered in the study. The patients received UFT (400 mg daily) administered orally for seven days prior to surgery and were randomly assigned to two groups immediately following surgery. Group A received MMC postoperatively; Group B received the same regimen as Group A, plus administration of UFT orally at a dose of 400 mg daily for one year. RESULTS: The survival results revealed no significant difference between groups A and B. In patients with nuclear DNA aneuploid tumors, the hematogenous recurrence rate after curative surgery was lower in Group B than in Group A (P = 0.0656). CONCLUSIONS: Preoperative and postoperative adjuvant oral UFT, administered with MMC after curative resection, may be effective in preventing hematogenous recurrence in colorectal cancer patients with nuclear DNA aneuploidy tumors.

[A case of spontaneous ruptured of the esophagus managed with pedicled omental covering].

We experienced a case of spontaneous rupture of the esophagus which was successfully managed by suture of the ruptured site and pedicled omental covering. A 47-year-old male was referred to our department in unstable condition 60 hours after the onset of acute symptoms. Upon presentation to the hospital, the patient was in shock and complained of severe chest pain and dyspnea, the onset of which followed vomiting after consumption of alcohol. A diagnosis of spontaneous rupture of the esophagus was made on the basis of the history of the episode and chest X-ray and chest CT findings. After construction of a pedicled omentum created during laparotomy, left-sided thoracotomy and debridment of the mediastinum was performed, which was seen to contain necrotic tissue and purulental fluid. The site of esophageal rupture, nearly 3 cm in length, was sutured shut and reinforced with a pedicled omental covering, the postoperative course was uneventful, and oral intake was resumed 20 days following the surgery. The pedicled omental covering procedure was useful for reinforcing sutures at the site of rupture and for control of infection in this patient for whom institution of surgical therapy for spontaneous esophageal rupture was delayed following the acute onset of symptoms.

[A 14-year-old with pulmonary hamartomatous lymphangiomyomatosis associated with bilateral pneumothoraces].

A 14-year-old girl was admitted because of cough, chest pain and hemosputum. Chest roentgenogram on admission showed a pneumothorax and a cavitary lesion with niveau formation in the right lung and cystic lesions in the bilateral lung fields. After bed rest and intravenous administration of antibiotics for two weeks, the right lung inflated well and the niveau formation disappeared, and the patient was discharged. One week later, she was readmitted with sudden-onset severe dyspnea, caused by bilateral pneumothoraces. Emergency tube thoracostomy and wedge resection of the bullous lesion was performed. Macroscopically, multiple small cystic changes were seen on the surface of the right lung. Histological examination revealed nodular proliferations of smooth muscle cells in the interstitium and vessel walls in the lung, which contained slit-like lymphatic channels. The diagnosis of pulmonary lymphangiomyomatosis was made. In this case, we could not measure receptors for estrogen and progesterone. Recently, hormonal therapy and oophorectomy have been reported as being useful. Tamoxifen (Norvadex) was therefore initiated, and the patient has remained well with slight dyspnea on exertion. There has been no recurrence of pneumothorax. Lymphangiomyomatosis is a rare disease of unknown etiology which occurs exclusively in women, mostly in those of reproductive age. We report a 14-year-old female patient with lymphangiomyomatosis associated with repeated pneumothorax, who had been under treatment for epilepsy. We believe this case to be of importance because of the long discussed relation between pulmonary lymphangiomyomatosis and tuberous sclerosis.

[The usefulness of UFT administration in colorectal cancer with emphasis on postoperative administration (Part 3)].

To investigate the usefulness of the postoperative administration of UFT for colorectal cancer, 109 patients with a history of colorectal cancers from Nagasaki University First Department of Surgery and seven affiliated facilities were selected as subjects. After administering UFT 400 mg/day to both A and B groups one week prior to surgery, MMC 20 mg during surgery and 10 mg on the first day after surgery, the groups were divided into an A group, not administered UFT, and B group, administered UFT 400 mg/day. In addition, both groups were administered MMC 6 mg/m2 six times a month starting the first month after surgery. Although the A group consisted of 54 patients and the B group 55, 52 patients of the A group and 46 patient of the B group, for a total of 98, qualified as subjects for this investigation, and the following results were obtained. 1) Postoperative administration of UFT was useful in prolonging the survival period in non-curable resection cases, in Dukes C group cases, and in cases that exhibited a nuclear DNA aneuploid pattern. It was especially useful in improving the postoperative survival rate from the second year on. 2) When recurrent cases were examined, it was found to be effective in preventing remote metastasis in those cases administered UFT postoperatively. 3) There were no serious adverse effects and the majority of those that did occur were anorexia and diarrhea.

Crow-Fukase syndrome associated with extramedullary plasmacytoma.

A patient with extramedullary solitary tumor had progressive sensory motor neuropathy, generalized pigmentation of skin, pretibial edema and gynecomastia. Serological examination of this patient showed monoclonal IgA-lambda gammopathy. Histologically, the tumor was defined as an IgA (lambda type) positive extramedullary plasmacytoma by using peroxidase anti-peroxidase staining. The tumor was accompanied by angiofollicular lymphoid hyperplasia. Pathologically, it was recognized as an extramedullary plasmacytoma associated with Castleman's disease like changes, and was successfully treated by surgical resection, followed by irradiation.