[A Case of Persistent Dysesthesia after Uneventful Spinal Anesthesia with Bupivacaine].

We report a case of persistent dysesthesia lasting over a year in a patient after uneventful spinal anes- thesia with bupivacaine. A 67-year-old woman received spinal anesthesia for transurethral resection of bladder tumor. The surgery was performed in lithotomy position taking 20 min. Dysesthesia was found in her left lower limb postoperatively. Postoperative magnetic resonance imaging (MRI) revealed lumbar spinal canal stenosis at the L4-5 level, but she did not have any neurological deficits preoperatively. In spite of conser- vative treatment, the dysesthesia persisted for a year. We suspect that neurological symptoms were potentially caused by the interaction of local anesthetic toxicity and lumbar spinal canal stenosis. This case emphasizes the importance of thorough consultation on potential neurological complications following spinal anesthesia including the possibility for prolonged sequelae. In addition an early imaging examination during follow up is quite informative in assessing the situation appropriately.

[Colonic perforation in a patient treated with combination chemotherapy for recurrent ovarian clear cell adenocarcinoma].

BACKGROUND: Colonic perforation due to colitis is a known and reported side effect of chemotherapy. CASE REPORT: A 53-year-old woman was treated with combination chemotherapy of irinotecan plus cisplatin for a recurrent ovarian clear cell adenocarcinoma. Steroid was also used for suspected interstitial pneumonia. After two cycles of treatment, she developed a colonic perforation. Emergency laparotomy was not performed because of poor performance status with multiple lung metastases, pleural effusion and pericardial effusion. Colonoscopy showed a perforated wall at the cecum, and a long tube with balloon was inserted for occlusion. In addition, a peritoneal drainage tube was inserted. Oral intake could be restarted for a while, but she died from tumor progression one and a half months after the diagnosis of perforation. CONCLUSION: Non-surgical management with peritoneal drainage and ileus tube was useful in this case of colonic perforation for preserving oral intake and quality of life.

[A case of advanced esophageal cancer with suspected tracheoesophageal fistula that responded to chemoradiotherapy].

Chemoradiotherapy combined cisplatin, 5-FU and radiation was carried out in an advanced esophageal cancer with suspected tracheoesophageal fistula after insertion of an expandable metallic stent. Regression of the primary tumor was observed, and oral intake could be started. Chemoradiotherapy after insertion of the expandable metallic stent was useful in this case of advanced esophageal cancer with suspected tracheoesophageal fistula.

[A case of recurrent breast cancer complicated with pericardial effusions and cardiac tamponade].

A 56-year-old female with breast cancer after left partial mastectomy and subaxillary lymph node dissection was treated with adjuvant chemoradiotherapy. After one year left lung metastasis and malignant pleural effusion had resisted and progressed against several types of chemotherapy. Although combination chemotherapy of trastuzumab and vinorelbine was started, pericardial effusions progressed. Emergent pericardiocentesis was performed, and the catheter was left in the pericardial space. The adenocarcinoma was detected from effusion. On days 3, 5 and 7, after further pericardial drainage, the intracavitary treatment with a 15 mg bolus of thiotepa and 30 mg hydrocortisone was administered, and the catheter was removed the following day. The recurrence of pericardial effusions was not seen in four months until death. Pericardiocentesis and intrapericardial instillation of thiotepa were effective in our case with pericardial effusions.

Distribution of immunoglobulin Fab fragment conjugated with HIV-1 REV peptide following intravenous administration in rats.

HIV-1 REV peptide (positions 34-50) is well-known as a cell-permeating peptide. In this study, we investigated the distribution of Fab fragment of immunoglobulin conjugated with REV peptide (REV-Fab) following intravenous administration in rats, and compared with those of the native Fab fragment (nFab). Radioiodinated REV-Fab or nFab ((125)I-REV-Fab or (125)I-nFab, respectively) was given in a single intravenous dose of 2 mg/kg (3 MBq/kg). Total radioactive and TCA-insoluble radioactive concentrations in blood, whole-body autoradiography (ARG), and urinary excretion rates were assayed following administration. Regarding blood and plasma, total radioactive and TCA-insoluble radioactive concentrations for (125)I-REV-Fab were remarkably lower than those for (125)I-nFab. In the whole-body ARG at 4 h after administration, (125)I-REV-Fab produced remarkably higher radioactivity in the adrenal gland, spleen, and liver, compared to (125)I-nFab. Regarding urinary excretion rates, approximately 70% of the radioactive dose was excreted in the form of a low-molecular-weight component by 24 h after administration for both samples. (125)I-REV-Fab may penetrate quickly from blood to adrenal gland, spleen, liver, and other tissues after intravenous administration to rats, and then did not stay in situ and was digested and excreted mostly via the renal route by 24 h. With these features, cell-permeating peptides are expected to help the development of new antibody pharmaceuticals.

[Combination chemotherapy with hepatic arterial infusion of 5-fluorouracil (5-FU) and systemic irinotecan (CPT-11) in patients with unresectable liver metastases from colorectal cancer].

PURPOSE: Hepatic arterial infusion (HAI) chemotherapy for hepatic metastasis from colorectal cancer has higher response rates compared with systemic chemotherapy, but can not control extrahepatic lesions. So the combination chemotherapy with HAI plus systemic chemotherapy is expected. This study ascertained the efficacy and toxicity of combined chemotherapy with HAI plus systemic CPT-11. METHODS: Seventeen patients were treated with concurrent HAI 5-FU 700-800 mg/m(2) on day 1, 8, 15, 22 and systemic CPT-11 70-80 mg/m(2) on day 1 and 15. Treatment was repeated every 28 days. RESULTS: The objective response rate for all patients was 76.5% (13 of 17 patients), and time to progression was about 10 months. Median survival time was about 20 months, and no difference was seen in the survival of patients without extrahepatic lesions and patients with extrahepatic lesions (21 months vs 18.5 months; p=0.5). The incidence of new extrahepatic metastasis in patients without extrahepatic lesions was 9% (1 of 11 patients). Grade 3 or 4 neutropenia was found in only 2 patients (11.8%). CONCLUSION: Combination therapy with HAI 5-FU plus systemic CPT-11 may be safely administered to patients with colorectal cancer. The incidence of new extrahepatic metastases was low in comparison with reports of HAI monotherapy.

[A case of advanced hepatocellular carcinoma with lung metastases and cirrhosis that responded to combination chemotherapy with interferon-alpha and 5-fluorouracil].

The prognosis for patients with hepatocellular carcinoma (HCC) with progressive liver cirrhosis or extrahepatic metastases remains dismal. We report a case of HCC with liver cirrhosis and lung metastases who had been treated successfully by combination chemotherapy of 5-fluorouracil (5-FU) and interferon-alpha (IFN-alpha). A 67-year-old male with a history of hepatitis C, liver cirrhosis and HCC was hospitalized because of cough and dyspnea. Computed tomography (CT) of chest revealed multiple lung metastases. Systemic combination chemotherapy with 5-FU and IFN-alpha was begun, and lung metastases disappeared after one course of treatment. He died of liver failure one year later, but no recurrence of lung metastases was seen. Although systemic combination chemotherapy of 5-FU and IFN-alpha induced the bone marrow suppression, it was effective for lung metastases and palliates symptoms and signs in our case of HCC.

[Possible approaches to cancer chemotherapy in palliative care medicine].

We discussed our attitude, ideas, and treatment practices, and presented several problems concerning palliative chemotherapy under the palliative medical environment in patients with advanced cancer in our hospital. We thought that, in many cases, they could be given further chemotherapy. Because of the clear availability of so-called palliative therapy, these patients tend not to elect another chemotherapy using more effective anti-tumor agents in the name of "acceptance." The clinical practice of palliative chemotherapy, however, really needs the passion of skillful medical oncologists, palliative care doctors, and other staff including surgeons and radiologists. The most important issue is that all the medical staff sincerely empathize with the wishes of patients and their families with a common hospice spirit.