Clinical characteristics of lower bowel perforation with chronic renal failure.

BACKGROUND/AIMS: This study was conducted to evaluate the clinical characteristics of lower bowel perforation (LBP) with chronic renal failure (CRF). METHODOLOGY: In 58 patients with LBP, clinical variables, such as findings of clinical examinations, operative findings, and results of laboratory blood tests were examined as possible prognostic factors for in-hospital death, and compared between CRF and non-CRF groups. RESULTS: Of the 58 patients, 21 died during hospitalization (mortality rate, 36.2%). The mortality rate of patients with CRF was 54.2%. In the patients with LBP, the following variables were significantly correlated with in-hospital death (p<0.05): hypotension, CRF, fecal peritonitis, and low white blood cell (WBC) count, and low albumin and base excess (BE) levels. The odds ratios of in-hospital death were highest for a WBC count of 9000/mm3 and a BE of -3mEqL. Between the CRF and non-CRF groups, significant differences in the rates of age < 70 years, fecal peritonitis, in-hospital death, and low WBC count and BE were found (p<0.05). CONCLUSIONS: We identified prognostic factors of LBP and demonstrated the clinical characteristics of LBP with CRF. These results indicate that patients who have LBP with CRF tend to have immediate sepsis and a poor prognosis.

Primary gas gangrene of the pancreas: report of a case.

Spontaneous gas gangrene of the pancreas, caused by an infection of Clostridium perfringens, is an extremely rare but severe form of acute pancreatitis. A 67-year-old man complaining of severe epigastric pain with diffuse guarding underwent an emergency laparotomy. During surgery, hemorrhagic pancreatic necrosis was observed with a large amount of peripancreatic gas. Cultures demonstrated C. perfringens. The identification of hemolysis and the accumulation of peripancreatic gas on computed tomography, which were both caused by an infection of C. perfringens, led us to make a diagnosis of clostridial infection of the pancreas.

[Lung adenocarcinoma with multiple pulmonary metastases completely responsive to combination chemotherapy with carboplatin and weekly paclitaxel--a case report].

We report a case in which lung adenocarcinoma with multiple pulmonary metastases was completely responsive to combination chemotherapy with carboplatin (CBDCA) and weekly paclitaxel (TXL). CBDCA AUC = 5 (day 1) and TXL 75 mg/m2 (day 1, 8, 15) were infused over 1 hour after short premedication on an outpatient basis. Administration was continued for 3 weeks followed by 1 week rest. The patient was a 54-year-old woman who suffered from lung adenocarcinoma with mediastinal lymph node metastases, stage III A, and underwent complete resection. However, multiple pulmonary metastases were found 3 years after operation. On an outpatient treatment, she was treated with CBDCA combined with weekly TXL for 6 cycles. The multiple pulmonary metastases had completely disappeared after 2 cycles and CEA decreased to within normal limit after 5 cycles. The toxic events were anemia (grade 2), leucocytopenia (grade 2) and alopecia (grade 3). No major adverse effects such as hypersensitivity reaction or peripheral neuropathy were observed.

[Gastrointestinal stromal tumor of the omentum: report of a case].

A 69-year old man was found a mass becoming larger in abdominal computed tomography. The mass consisted of intermingling solid and cystic component was located below the liver. Abdominal angiography showed tumor staining supplied from right gastroepiploic artery. We considered the mass cystadenoma, lymphangioma, cystic mesothelioma, or gastrointestinal stromal tumor (GIST) preoperatively, and then surgical resection was performed. The tumor was found localized in the greater omentum. Pathological examination showed the tumor composed of proliferation of atypical sort spindle cells and tumor cells were immunohistochemically positive for C-KIT and CD34, identifying the tumor as a primary GIST of the greater omentum.

[Effective weekly paclitaxel administration for gastric cancer with malignant ascites--a case report].

We report a case in which weekly paclitaxel (TXL) administration was effective for gastric cancer with malignant ascites. TXL (80 mg/m2) was infused over 1 hour after short premedication on an outpatient basis. Administration was continued for 3 weeks followed by 1 week rest. The patient was a 49-year-old woman who suffered from non-resectable gastric cancer, staged intraoperatively as having severe lymph node metastasis and malignant ascites. As an outpatient treatment, she was first treated with 5-fluorouracil combined with high-dose Leucovorin for 4 cycles. However, she complained of abdominal fullness and ascites, and received weekly TXL administration as the second line treatment. The ascites had completely disappeared 3 months after administration. The toxic events were anemia (grade 1) and alopecia (grade 2). No major adverse effects such as hypersensitivity reaction, leukopenia or peripheral neuropathy were observed.