Cystic duct with no visible signal on magnetic resonance cholangiography is associated with laparoscopic difficulties: an analysis of 695 cases.

BACKGROUND/AIMS: We investigated the association between the magnetic resonance cholangiography (MRC) results and surgical difficulties and bile duct injuries during laparoscopic cholecystectomy (LC). METHODS: MRC was performed on 695 consecutive patients before LC. We divided the patients into two groups (visible cystic duct group and "no signal" cystic duct on MRC group) and compared them with regard to the length of the operation, conversion rate to open cholecystectomy (OC) and rate of bile duct injury. RESULTS: The "no signal" cystic duct on MRC group had a longer operation and higher rate of conversion to OC compared with the visible cystic duct group. However, there was no statistically significant difference in the occurrence rate of bile duct injury between the two groups. CONCLUSIONS: The "no signal" cystic duct on MRC group was associated with laparoscopic difficulties, but not with an increased rate of biliary injury. When a visible cystic duct is not observed on MRC an early conversion to open surgery may avoid a bile duct injury during LC.

[Two resected cases of pulmonary metastasis from post operative colorectal cancer after preoperative chemotherapy with FOLFOX].

UNLABELLED: We described two resected cases of pulmonary metastasis from postoperative colorectal cancer after preoperative FOLFOX chemotherapy. Pathologic histology inspection of the tumor was judged to be effective prior to resection. The first case is a 68-year-old male who underwent a sigmoidectomy as a stage III A sigmoid colon cancer in March 2003. Afterwards, distant metastases had occurred to the liver, the left lung and neck lymph nodes from 2003 to 2006. Three operations and systemic chemotherapy were performed. A new metastasis of the right lung occurred in November 2006. The FOLFOX chemotherapy was performed 7 times, the tumor was not changed in the image, and the effect judgment was SD. After the chemotherapy, a partial resection of the right lung was performed in November 2007. Half of the tumor resulted in necrosis on the specimen (Grade 1b). The second case is a 63-year-old female who underwent an anterior resection of the rectum as a stage II rectal cancer in January 2000, a partial resection of the right lung as a metachronous right pulmonary metastasis in March 2003, and post operative chemotherapy (IFL) were performed. A new metastasis of the right lung occurred in September 2005. The FOLFOX chemotherapy was performed 4 times, the tumor was not changed in the image, and the effect judgment was SD. After the chemotherapy, a partial resection of the right lung was performed in April 2006. One third of the tumor resulted in necrosis on the specimen (Grade 1a). COMMENT: It was thought that FOLFOX chemotherapy can be a promising candidate for neoadjuvant treatment of pulmonary metastasis from postoperative colorectal cancer.

[Evaluation of bronchial arterial infusion (BAI) for lung cancer with carcinomatous pleuritis].

MATERIALS AND METHODS: Six high-risk patients of lung cancer with carcinomatous pleuritis to which BAI was done were examined. BAI was performed using CDDP (40-50 mg/m2) + CPT-11 (40-50 mg/m2). The therapeutic effects, side effects, a reduction of the symptoms and prognosis were examined. RESULTS: All cases were revealed as stable disease according to the rule of the RECIST. The side effect of appetite loss for over grade 2 was found in one case. The reduction of respiratory symptoms (cough, dyspnea at the movement in 3, chest pain in 1 and loss of the movement in 1) was recognized by four out of five cases. Five patients died in three to seven months after the treatment of BAI. The causes of death were the recurrence of carcinomatous pleuritis and the primary lesion or the metastasis lesion of the lung in 4 cases and the recurrence of the primary lesion in 1 case. The recurrence of the malignant pleural effusion was recognized in 1 case without intra-thoracic infusion. COMMENT: BAI was effective as a reduction of the respiratory symptoms in the high-risk patients of lung cancer with carcinomatous pleuritis. It appeared that a long-term survival was probable with the combination of BAI, intra-thoracic infusion and systemic chemotherapy.

[Carboplatin and CPT-11 chemotherapy in a hemodialysis patient with small-cell lung cancer].

We administered a dose-down chemotherapy, which was a combination of carboplatin 100 mg/body (AUC 3.0, day 1) and CPT-11 30 mg/m2 (day 1, day 15) to the patient with a poor performance status of extensive small-cell lung cancer with renal failure. Hemodialysis was performed two hours after the chemotherapy. We measured plasma levels of total-platinum and CPT-11 and metabolic products (SN-38) after the hemodialysis. The results of pharmacokinetic study showed a high level collection of total-platinum caused by carboplatin and SN-38, and that was caused by CPT-11 in the blood. Although the grade 3 of granulocytopenia was found, the decrease in tumor marker and an improvement of the ADL were confirmed. It thought that this chemotherapeutic regimen was effective for small-cell lung cancer with renal failure undergoing hemodialysis. Further study is needed for a selection of suitable chemotherapeutic regimens, an optimal dosage of each drug and timing of hemodialysis.

High molecular weight form insulin-like growth factor II-producing mesenteric sarcoma causing hypoglycemia.

An 81-year-old woman presented with frequent episodes of hypoglycemia. Her serum level of insulin was normal, but her serum insulin-like growth factor (IGF)-II level was high. She was found to have a spindle cell sarcoma originated from the mesentery of the sigmoid colon, which was completely resected. Postoperatively, hypoglycemia ameliorated with concomitant reduction in serum IGF-II levels. Immunohistochemical study revealed positive immunostaining for IGF-II in tumor cells, and the abundant expression of IGF-II mRNA was demonstrated by RT-PCR. The presence of high molecular weight (HMW) form IGF-II in patient's serum was confirmed by immunoblotting. This is the first report of a patient with HMW form IGF-II-producing mesenteric sarcoma causing hypoglycemia.

A crescent-shaped sparing proximal to a liver tumor may indicate underlying portal tumor thrombus.

A primary or metastatic liver tumor sometimes blocks portal venous flow and causes a focal sparing in the fatty liver. We herein report a case of segmental sparing due to the portal tumor thrombus extending from the metastatic liver tumor. The present case demonstrates characteristic computer-associated tomographic findings, a distal oval hypodense tumor with proximal "crescent-shaped sparing", which may indicate underlying portal tumor thrombus at the apex of the sparing.