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1.
Surg Case Rep ; 10(1): 118, 2024 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-38736003

RESUMO

BACKGROUND: Laparoscopic cholecystectomy (LC) is one of the most commonly undertaken procedures worldwide for cholecystolithiasis and cholecystitis. Accessory liver lobe (ALL) is a developmental anomaly defined as an excessive liver lobe composed of a normal liver parenchyma. Some ALL exist on the serosal side of the gallbladder. We herein present two cases of ALL incidentally detected during LC. CASE PRESENTATION: The first case was a 69-year-old woman diagnosed with chronic cholecystitis. LC was performed. ALL was observed anterior to the wall of the gallbladder and resected after clipping. Pathological findings revealed liver tissue with Glisson's capsule and a lobular structure in ALL. However, communication between the bile ducts of ALL and the main liver was unclear due to surgical heat degeneration. The second case was a 56-year-old woman diagnosed with acute cholecystitis. LC was performed approximately one month after the attack, and ALL attached to the wall of gallbladder. ALL was clipped and completely resected. Pathological findings showed that the bile ducts of ALL might be connected within the wall of gallbladder. CONCLUSIONS: We presented two cases of ALL attached to the gallbladder encountered during LC. Since ALL contains a normal liver parenchyma, postoperative bleeding or bile leakage may occur if it is inefficiently resected. Therefore, the complete resection of ALL is important to prevent these postoperative complications.

2.
J Surg Case Rep ; 2018(4): rjy064, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29644045

RESUMO

The guideline for the treatment of rectal prolapse recommends that surgeons select appropriate surgical procedures individually based on each patient's overall status. However, in cases of irreducible or incarcerated rectal prolapse, surgical options are quite limited. Here we present a case of an elderly woman with massive chronic irreducible rectal prolapse. An 87-year-old woman presented to our hospital with a complaint of massive rectal prolapse. The prolapsed rectum was over 20 cm long, and completely irreducible. She underwent perineal rectosigmoidectomy with levatorplasty known as Altemeier's procedure. More than 30 cm of rectosigmoid colon was resected. After the operation, rectal prolapse was resolved completely. Her postoperative course was uneventful, and her quality of life and bowel movements improved. She has since been healthy without recurrence for over 2 years. Altemeier's procedure is applicable even in cases of irreducible rectal prolapse and features acceptable safety and a satisfactory outcome.

3.
Gan To Kagaku Ryoho ; 45(3): 557-559, 2018 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-29650937

RESUMO

An 84-years-old man underwent total gastrectomy with D1 plus lymph node dissection in December 2015, and diagnosed as Stage III B neuroendocrine carcinoma of the stomach. An abdominal computed tomography revealed swollen paraaortic lymph nodes and left adrenal grand in May 2016. Since his serum level of CA19-9 was elevated, he was thus diagnosed as having recurrence, and was started chemotherapy with ramucirumab(RAM). After introduction of the chemotherapy, his serum level of CA19-9 was decreased gradually and metastatic foci were also decreased in size. Although the patient required relatively longer administration interval according to the severity of general fatigue, he continued the chemotherapy without severe adverse effects until he rejected further treatment in January 2017, and satisfactory therapeutic result was acquired. While the prognosis of gastric neuroendocrine carcinoma is reported to be very poor, no definitive therapeutic guideline is available at present. Especially in elderly patients, we should pay considerable attention to the selection of chemotherapeutic agents because of their own adverse effects. In the present case, RAM could be administered safely, and it seemed that RAM might become a useful therapeutic option for gastric neuroendocrine carcinoma even in elderly patients.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Antineoplásicos/uso terapêutico , Carcinoma Neuroendócrino/tratamento farmacológico , Neoplasias Gástricas/tratamento farmacológico , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Humanizados , Carcinoma Neuroendócrino/cirurgia , Quimioterapia Adjuvante , Evolução Fatal , Humanos , Masculino , Recidiva , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Ramucirumab
4.
Surg Laparosc Endosc Percutan Tech ; 27(5): 379-383, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28727634

RESUMO

The feasibility of single-incision laparoscopic cholecystectomy (SIL-C) for patients with acute cholecystitis were evaluated based on the timing of operation after onset of symptoms. Sixty patients with acute cholecystitis who underwent SIL-C were divided into 2 groups according to the timing of operation: group E included 23 patients who underwent SIL-C within 72 hours, and group O included 37 patients who underwent SIL-C later. There were no statistical differences between group E and group O in clinicopathologic characteristics. Group E demonstrated significantly shorter operating time and less blood loss than group O. Although the incidences of additional port(s) requirements were not significantly different, 8 patients in group O required open conversion, indicating significantly higher rate. As group E demonstrated favorable surgical outcomes compared with group O, SIL-C for acute cholecystitis seems to be a feasible therapeutic procedure when performed within 72 hours as updated Tokyo Guidelines recommended.


Assuntos
Colecistectomia Laparoscópica/métodos , Colecistite Aguda/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica , Conversão para Cirurgia Aberta/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
5.
Gan To Kagaku Ryoho ; 44(12): 1440-1442, 2017 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-29394661

RESUMO

Single-incision laparoscopic surgery(SILS)is superior to multiport laparoscopic surgery in terms ofcosmetics, but in other terms it is still disputable and needs further investigation. The treatment of SILS for colon cancer has increased, however, the feasibility of single-incision laparoscopic colectomy(SILC)for patients over 90 with colon cancer has not been well examined. We report 2 cases ofsingle -incision laparoscopic ileocecal resection without complications. Case 1: A 104-year-old woman who had been diagnosed with pStage III a obstructive ascending colon cancer. There were no perioperative complications. She was discharged 15 days after the operation. During the 26 months of follow-up, there was no evidence oflocal recurrence or distant metastasis. Case 2: A 90-year-old woman who had been diagnosed with pStage I cecal cancer. There were no perioperative complications. She was discharged 10 days after the operation. Single-incision laparoscopic ileocecal resection for the aged patients is feasible when performed on patients selected by surgeons with extensive SILC experience.


Assuntos
Neoplasias do Colo/cirurgia , Idoso de 80 Anos ou mais , Colectomia , Feminino , Humanos , Laparoscopia , Resultado do Tratamento
6.
Gan To Kagaku Ryoho ; 44(12): 1726-1728, 2017 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-29394756

RESUMO

A 44-years-old man presented to our hospital with bloody stool. CT of the abdomen revealed a 90mm mass adjacent to small intestine and high density ascites in lower abdomen. On the day of the admission, he lapsed into hemorrhagic shock caused by gastrointestinal bleedings. So emergency operation was performed. Operative findings showed a solid tumor of small intestine that were 95mm in diameter and a small amount of bloody ascites(100mL). Another tumor was also found in analis small intestine from primary lesion. Small bowel resections were performed for each lesion. Resected specimen showed the solid tumor, 95×70×50mm in size, in the small intestine. Histopathological findings showed outgrowth of spindle cells from the proper muscular layer to the subserosal layer. Immunohistochemical findings revealed positive staining for c-kit and CD34. c-kit positive GIST was thus diagnosed. Chemotherapy with imatinib was administered after surgery and the patient has been free from recurrent disease for 6 months after surgery.


Assuntos
Tumores do Estroma Gastrointestinal/cirurgia , Neoplasias Intestinais/cirurgia , Complicações Intraoperatórias , Choque Hemorrágico/etiologia , Adulto , Antineoplásicos/uso terapêutico , Quimioterapia Adjuvante , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Humanos , Mesilato de Imatinib/uso terapêutico , Neoplasias Intestinais/tratamento farmacológico , Neoplasias Intestinais/patologia , Intestino Delgado/patologia , Masculino
7.
Gan To Kagaku Ryoho ; 43(12): 2407-2409, 2016 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-28133337

RESUMO

A 76-year-old man underwent radical surgery for Stage IV a hilar cholangiocarcinoma in July 2009, and had been followed at an outpatient clinic. Although no apparent recurrent lesion was detected by PET/CT examination, an elevated CA19-9 level was found in January 2014. He was then started on the oral anticancer drug S-1. However, his CA19-9 level increased gradually. The patient presented to a urological department with a complaint of macrohematuria in May 2015. Detailed examination revealed a mass lesion at the top of the urinary bladder, which was suspected to be peritoneal dissemination of the known hilar cholangiocarcinoma invading the urinary bladder wall. Thus, he underwent partial resection of the urinary bladder in July 2015. A histopathological examination of the resected specimen confirmed the diagnosis of recurrence. The patient is nowreceiving chemotherapy with gemcitabine and cisplatin. Detection of recurrences of cholangiocarcinoma is often difficult since the recurrence pattern of cholangiocarcinoma varies widely. However, early detection might enable longterm survival by adequate treatment including chemotherapy. Therefore, thorough multidisciplinary examinations are required when recurrence of cholangiocarcinoma is suspected. In addition, long-term follow-up after radical surgery is required since cholangiocarcinoma sometimes shows slow progression.


Assuntos
Neoplasias dos Ductos Biliares/patologia , Hematúria/etiologia , Tumor de Klatskin/secundário , Neoplasias Peritoneais/secundário , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias dos Ductos Biliares/cirurgia , Cisplatino/administração & dosagem , Desoxicitidina/administração & dosagem , Desoxicitidina/análogos & derivados , Humanos , Tumor de Klatskin/tratamento farmacológico , Tumor de Klatskin/cirurgia , Masculino , Neoplasias Peritoneais/tratamento farmacológico , Fatores de Tempo , Gencitabina
8.
Gan To Kagaku Ryoho ; 43(12): 2462-2464, 2016 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-28133355

RESUMO

A-77-year-old man presented to our hospital with high fever and lower abdominal pain. Enhanced CT of the abdomen revealed swelling of the appendix with wall thickening and fluid collection. We diagnosed appendicitis with abscess formation and performed transumbilical laparoscopic-assisted appendectomy after the inflammation improved in response to antibiotics. Operative findings revealed a cystic lesion ofthe appendix and strong adhesion ofthe appendix to the terminal ileum. Based on these operative findings, we changed the operative procedure to a single-incision laparoscopic assisted ileocecal resection because ofthe possibility ofhydrops processus vermiformis. Histopathological findings revealed hyperplasia ofthe glandular epithelium with nuclear enlargement. Mucinous cystadenocarcinoma ofthe appendix was diagnosed. Additional surgery was not performed due to the patient's request. The patient has been free from recurrent disease for approximately 6 months after the surgery. Transumbilical laparoscopic-assisted appendectomy is useful for preventing pseudomyxoma peritonei and easing changes in extended operations for suspected cases of hydrops processus vermiformis.


Assuntos
Apendicectomia , Neoplasias do Apêndice/cirurgia , Cistadenocarcinoma Mucinoso/cirurgia , Laparoscopia , Dor Abdominal/etiologia , Idoso , Neoplasias do Apêndice/complicações , Neoplasias do Apêndice/patologia , Cistadenocarcinoma Mucinoso/complicações , Humanos , Masculino
9.
Case Rep Surg ; 2015: 942393, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25861511

RESUMO

We herein report a 66-year-old female patient who developed an undiagnosed small bowel obstruction without a history of prior abdominal surgery and was successfully treated by single-incision laparoscopic surgery. A small bowel obstruction with unknown cause typically requires some sort of surgical treatment in parallel with a definitive diagnosis. Although open abdominal surgery has been generally performed for the treatment of small bowel obstructions, laparoscopic surgery for small bowel obstructions has been increasing in popularity due to its less invasiveness, including fewer postoperative complications and a shorter hospital stay. As a much less invasive therapeutic strategy, we have performed single-incision laparoscopic surgery for the treatment of an undiagnosed small bowel obstruction. We were able to make a definitive diagnosis after sufficient intra-abdominal inspection and to perform enterotomy through a small umbilical incision. Single-incision laparoscopic surgery appears to be comparable to conventional laparoscopic surgery and provides improved cosmesis, although it is an optional strategy only applicable to selected patients.

10.
Gan To Kagaku Ryoho ; 42(12): 2024-6, 2015 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-26805252

RESUMO

We present a case of gastritis cystica polyposa (GCP) that developed early after laparoscopy-assisted distal gastrectomy with BillrothⅠreconstruction. GCP is a chronic inflammatory gastric mucosal lesion that emerges at an anastomotic site usually after a long post-gastrectomy period, which is mainly caused by constant chemical stimulation by duodenal juice. In addition, chronic mechanical stimulation caused by reflux or stasis of gastrointestinal contents may also trigger GCP. Surgeons should ensure a functional and physiologically patent anastomosis during surgery. Hypergastrinemia, caused by persistent Helicobacter pylori infection or continuing administration of proton pump inhibitors, may also contribute to the development of GCP, as GCP is a type of hyperplastic polyp. Therefore, appropriate postoperative follow-up, including pylorus eradication and avoidance of unnecessary administration of proton pump inhibitors, seems to be needed in order to prevent the development of GCP. In our case, many factors exhibited the multiplier effect, resulting in early development of GCP. As GCP also attracts much attention as a precancerous lesion, appropriate prevention and prompt treatment are required.


Assuntos
Pólipos Adenomatosos/terapia , Gastrectomia/efeitos adversos , Gastrite/terapia , Infecções por Helicobacter/terapia , Helicobacter pylori , Neoplasias Gástricas/terapia , Pólipos Adenomatosos/etiologia , Idoso de 80 Anos ou mais , Gastrite/etiologia , Infecções por Helicobacter/complicações , Humanos , Masculino , Neoplasias Gástricas/etiologia , Tomografia Computadorizada por Raios X
11.
Gan To Kagaku Ryoho ; 42(12): 2218-20, 2015 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-26805316

RESUMO

A 44-year-old man presented to our hospital with high fever and right side ache. Laboratory data revealed the presence of inflammation. Enhanced CT of the abdomen revealed a 15 cm mass of the ascending colon, and FDG-PET showed abnormal uptake in the same site. Colonofiberscopy demonstrated an elevated lesion in the ascending colon without malignant findings in biopsies. Enema examination revealed an extrinsic compression of the ascending colon. Although the patient received antibiotic therapy, there were no signs of improvement. Therefore, right hemicolectomy with resection of the invasive lesion of the right abdominal wall and the jejunum was performed. The resected specimen showed a solid tumor, 17×11×8 cm in size, in the ascending colon. The tumor invaded the ileum. Immunohistochemical findings revealed positive staining for NSE, synaptophysin, and chromogranin A. Neuroendocrine carcinoma was thus diagnosed. CPT-11-containing chemotherapy was administered for 1 year after surgery. The patient has been free from recurrent disease for over 7 years after surgery.


Assuntos
Carcinoma Neuroendócrino , Neoplasias do Colo/patologia , Jejuno/patologia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Neuroendócrino/tratamento farmacológico , Carcinoma Neuroendócrino/cirurgia , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/cirurgia , Humanos , Metástase Linfática , Masculino , Invasividade Neoplásica , Fatores de Tempo , Resultado do Tratamento
12.
Surg Today ; 45(10): 1245-9, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25231940

RESUMO

PURPOSE: To compare the surgical outcomes after transumbilical laparoscopic-assisted appendectomy (TULAA) and open appendectomy (OA) at a single institution. METHODS: We compared the surgical outcomes for 94 consecutive patients who underwent TULAA between April 2010 and March 2014 to those for 91 consecutive patients who underwent OA between April 2006 and March 2010. RESULTS: There were no significant differences in the clinicopathological backgrounds between the two groups. Although the lengths of the operations were similar in both groups, the postoperative hospital stay was significantly shorter in the TULAA group (4.7 days vs. 5.4 days, P = 0.02). The need for abdominal drain insertion was significantly reduced in the TULAA group owing to sufficient intraperitoneal exploration (P = 0.03). The incidence of postoperative complications was also lower in the TULAA group, but the difference was not significant (8.6 % vs. 12.1 %, P = 0.31). In complicated cases, a lower incidence of surgical site infection was confirmed in the TULAA group (6.7 % vs. 20.7 %, P = 0.12). CONCLUSION: Our results demonstrated that TULAA provided better surgical outcomes, especially a faster recovery. TULAA could be an effective procedure incorporating both open and laparoscopic techniques, and can be implemented as a standard procedure for the treatment of appendicitis, regardless of disease severity.


Assuntos
Apendicectomia/métodos , Apendicite/cirurgia , Laparoscopia/métodos , Cirurgia Assistida por Computador/métodos , Umbigo/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
13.
Gan To Kagaku Ryoho ; 41(12): 1583-5, 2014 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-25731260

RESUMO

The purpose of this study was to evaluate the outcome of treating obstructive left-sided colon cancer with a combination of self-expandable metallic stent (SEMS) insertion and laparoscopic surgery. Ten patients were included in this study. Two patients had obstructive transverse colon cancer, and eight had obstructive sigmoid colon cancer. The patients had a SEMS inserted preoperatively as a bridge to surgery. Efficient decompression was achieved in all the patients, without any complications. Normal oral intake was possible until the laparoscopic, or laparoscope-assisted, one-stage radical operation. The SEMS insertion did not affect the surgical maneuver or laparoscopic operation at all. None of the patients developed any postoperative complications. After surgery, five patients were diagnosed with Stage II disease and three patients were diagnosed with Stage IIIA disease. The remaining two patients had distant metastasis (para-aortic lymph node and liver) and were diagnosed with Stage IV disease. Chemotherapy was administered to the two patients with Stage IV disease after a comparatively early recovery from a less invasive surgical procedure. SEMS insertion appears to be an effective, less invasive decompression method. When used in combination with laparoscopic surgery, SEMS insertion appears to be a safe and less invasive method of treating obstructive left-sided colon cancer.


Assuntos
Neoplasias do Colo/complicações , Obstrução Intestinal/cirurgia , Laparoscopia , Stents , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Obstrução Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Resultado do Tratamento
14.
J Minim Access Surg ; 8(4): 161-2, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23248448

RESUMO

The traditional anvil grasper may be difficult to use for connecting the stem of an anvil with the centre rod of a circular stapler because the grasper holds the anvil completely still. In addition, the head angle is fixed and cannot handle the anvil head delicately in a tight pelvic space. Many surgeons use a grasper designed for holding the bowel or a dissector for holding the anvil during intra-corporeal circular stapled anastomosis during low anterior resection, sigmoidectomy, left hemi colectomy and know that it is difficult to connect segments with these instruments due to slipping. A new modified anvil grasper was developed with curved blades that can easily grasp the stem of an anvil and smoothly connect it with the centre rod of the circular stapler. This grasper should be useful for surgeons performing laparoscopic intra-corporeal circular stapled anastomoses, which are the most challenging part of laparoscopic colorectal surgery.

15.
Asian J Endosc Surg ; 5(4): 204-6, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23095302

RESUMO

Traditional anvil graspers cannot delicately handle the anvil head as a result of their unique jaw shape that enhances grip force, and they are not suitable for confined pelvic space. With a manufacturing company, we developed a novel anvil grasper, the evolutional anvil grasper for laparoendoscopic surgery (EAGLE), to ensure more precise and safer anastomosis procedures. The EAGLE has curved blades that create a 6-mm grasping surface that is the same diameter as the anvil stem and is covered with tungsten carbide tips. When using the EAGLE, a surgeon grasps the anvil stem slightly and easily, handles the anvil head and proximal colon, and smoothly sets the anvil to the center rod of the circular stapler. A surgeon can also securely grasp the stem of the anvil, push it into the center rod of the circular stapler and then perform a sequence of actions in anastomosis procedures smoothly and safely.


Assuntos
Anastomose Cirúrgica/instrumentação , Cirurgia Colorretal/instrumentação , Laparoscopia/instrumentação , Grampeamento Cirúrgico/instrumentação , Humanos , Laparoscopia/métodos
16.
J Laparoendosc Adv Surg Tech A ; 22(8): 812-4, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22973858

RESUMO

INTRODUCTION: When a large gauze is needed during a single-incision surgery or reduced port surgery using slim (5-mm) trocars, the operation needs to be interrupted to introduce the gauze via an incision or to change to a large trocar. We describe here a novel procedure for introducing a large gauze into the corporeal cavity by using a slim trocar, called the "Tornado gauze procedure" (TGP). MATERIALS AND METHODS: Commercially packed Trox(®) (Osaki Medical, Nagoya, Japan) gauze (30×150 mm, 4-ply) and a specially ordered precision stainless steel tube (Smart introducer; Kinugawa Factory, Kyoto, Japan) are used for the TGP. The gauze is screwed into the Smart introducer. When the surgeon needs a gauze, a Smart introducer with a gauze is set into the 5-mm trocar; then, the 5-mm grasper is used to push the gauze into the corporeal cavity with small screwing-in movements. The gauze is also gently removed from the corporeal cavity through a 5-mm trocar. RESULTS: This procedure efficiently and safely introduced the gauze for hemostasis, blunt dissection, suction filtering, and organ retraction without interrupting the pneumoperitoneum to introduce the gauze in single-incision laparoscopic cholecystectomy, transabdominal preperitoneal hernia repairs, and appendectomy, with good visualization and adequate working space. The rhythm of surgery remains undisturbed with the use of the TGP, even in a high-risk and high-stress situation. The port's valves were not disabled during surgery, and no procedure-related complications were reported. CONCLUSIONS: TGP is expected to be helpful to surgeons and enhance the safety of laparoscopic surgeries involving the use of slim trocars.


Assuntos
Hemostase Endoscópica/instrumentação , Laparoscopia/instrumentação , Laparoscopia/métodos , Tampões de Gaze Cirúrgicos , Colecistectomia Laparoscópica/instrumentação , Colecistectomia Laparoscópica/métodos , Desenho de Equipamento , Humanos , Pneumoperitônio Artificial
17.
Gan To Kagaku Ryoho ; 38(12): 1995-7, 2011 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-22202263

RESUMO

A 75-year-old man, who was on maintenance hemodialysis, underwent a radiotherapy for locally recurrence of rectal cancer. A pain palliation was achieved and serum tumor markers were reduced. However, after six months, a tumor re- growth was detected and sacral pain was increased. Then, a radiofrequency ablation (RFA) was performed repeatedly as a palliative therapy and pain palliation was achieved. RFA is a safe and effective palliative therapy for patients of poor-risk, such as a terminal stage or hemodialysis patient. Furthermore, it is able to perform repeatedly when the response was not satisfactory. However, a Cool-tip electrode could not to be placed because tumors were hardened by radiotherapy and a repeat of RFA. Then a development of novel Cool-tip electrode may be needed.


Assuntos
Ablação por Cateter , Neoplasias Pélvicas/cirurgia , Neoplasias Retais/terapia , Diálise Renal , Idoso , Evolução Fatal , Humanos , Masculino , Neoplasias Pélvicas/radioterapia , Neoplasias Pélvicas/secundário , Neoplasias Retais/patologia , Recidiva , Tomografia Computadorizada por Raios X
18.
Gan To Kagaku Ryoho ; 37(5): 935-7, 2010 May.
Artigo em Japonês | MEDLINE | ID: mdl-20495333

RESUMO

A 70-year-old male visited the hospital with a complaint of stomachache. Hydronephrosis was observed in the right kidney, and further examination confirmed a diagnosis of metastatic cancer limited to the bladder and rectovesical pouch after surgery for differentiated gastric cancer. Chemotherapy using paclitaxel(PTX)/S-1 was initiated. One course included 14 days of administration of S-1 (100 mg/body) followed by a 7-day interval, and the administration of PTX (60 mg/body) on the 1st and 15th days. General malaise developed after 4 courses, the dose of S-1 was reduced (80 mg/body), and PTX was administered only on the 1st day. CT conducted 9 months after the start of chemotherapy revealed the disappearance of ascites, decreased thickness of the bladder wall, and reduced size of the tumor in the rectovesical pouch. No new distal metastasis or peritoneal metastatic nodule has been observed, and there has been no tendency toward exacerbation for one year after the initial diagnosis. PTX/S-1 was suggested to be an effective treatment for metastatic cancer limited to the bladder and rectovesical pouch after surgery for differentiated gastric cancer.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ácido Oxônico/uso terapêutico , Paclitaxel/uso terapêutico , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologia , Tegafur/uso terapêutico , Neoplasias da Bexiga Urinária/tratamento farmacológico , Idoso , Diferenciação Celular , Combinação de Medicamentos , Humanos , Masculino , Ácido Oxônico/administração & dosagem , Paclitaxel/administração & dosagem , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/cirurgia , Tegafur/administração & dosagem , Tomografia Computadorizada por Raios X , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/secundário
19.
Gan To Kagaku Ryoho ; 37(12): 2421-3, 2010 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-21224593

RESUMO

A case was a 57-year-old man. Despite a diagnosis of cStage IV gastric cancer (cN2, cH0, cM0, cT3 (SE), cP1), we preferentially performed a non-curative surgery to avoid stenosis or bleeding by tumor invasion. Since no evidence of peritoneal metastasis was found at surgery, distal gastrectomy with D2 lymph node dissection was performed, and lymph nodes anterior to the pancreatic head were sampled. The pathological diagnosis was pT3 (SE), pN2, sH0, pM1 (LYM), pStage IV. After the surgery, S-1 was administered. One year and 9 months later, a solitary metastasis was found in S6 of the liver, and the patient underwent radiofrequency ablation (RFA) followed by adjuvant S-1. Currently, 5 years and 10 months after the surgery, the patient is under follow-up, and remains alive with recurrence-free. We speculate that in the presence of N or M (LYM) factors for stage IV gastric cancer, surgery with lymphadenectomy, which does not prevent the completion of adjuvant chemotherapy, followed by multimodal treatments such as continued chemotherapy and RFA, led to the long-term survival.


Assuntos
Neoplasias Hepáticas/secundário , Segunda Neoplasia Primária/secundário , Neoplasias Gástricas/patologia , Neoplasias Gástricas/terapia , Antimetabólitos Antineoplásicos/uso terapêutico , Ablação por Cateter , Terapia Combinada , Intervalo Livre de Doença , Combinação de Medicamentos , Gastrectomia , Humanos , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Ácido Oxônico/uso terapêutico , Tegafur/uso terapêutico , Resultado do Tratamento
20.
Gan To Kagaku Ryoho ; 36(12): 2260-2, 2009 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-20037389

RESUMO

The patient was a 43-year-old female who consulted a local physician due primarily to lower abdominal pain. She was referred to our hospital for close evaluation and treatment. Since circumferential cancer was detected in the transverse colon by lower digestive tract endoscopy, the patient was hospitalized for surgical treatment. Transverse colectomy (Cur A) was performed, histopathological examination indicated signet-ring cell carcinoma of the transverse colon, and the lesion was diagnosed as type 4, SS, ly3, v0, n1 (+), Stage III a. Postoperative adjuvant chemotherapy was recommended, but the patient was psychologically unstable and strongly rejected chemotherapy. The patient was periodically followed-up after surgery, but a mass was detected in the left ovary by CT after 1 year and 6 months, and bilateral ovariectomy was performed with a diagnosis of ovarian metastasis. The histopathological diagnosis was signet-ring cell carcinoma, and the ovarian lesions were judged to be metastases of the transverse colon carcinoma. Since the patient did not consent to postoperative chemotherapy, as after the initial surgery, she was followed-up without treatment. She was admitted with ileus due to peritoneal metastasis 4 years and 10 months after the initial surgery, and, despite of the surgery, she died due to carcinoma 5 years after the initial surgery.


Assuntos
Carcinoma de Células em Anel de Sinete/patologia , Carcinoma de Células em Anel de Sinete/secundário , Colo Transverso , Neoplasias do Colo/patologia , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/secundário , Neoplasias Ovarianas/secundário , Neoplasias Ovarianas/cirurgia , Adulto , Carcinoma de Células em Anel de Sinete/cirurgia , Neoplasias do Colo/mortalidade , Feminino , Humanos , Neoplasias Primárias Múltiplas/cirurgia , Ovariectomia
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