[Locally Advanced Gastric Cancer Treated with Curative Gastrectomy and Showing Pathological Complete Response after Chemotherapy with S-1].

A 77-year-old man presented with epigastralgia. Gastrointestinal endoscopic examination showed advanced gastric cancer, type 3, in the distal antrum. The patient refused surgery and preferred chemotherapy. The regimen consisted of 80 mg/body/day of S-1, continuously administered from day 1-14, followed by discontinuation for 2 weeks. After 2 courses, the patient experienced fatigue and recurrent vomiting. Laboratory studies revealed severe anemia; the hemoglobin level was 5.5 g/dL. An upper gastrointestinal endoscopy revealed pyloric stenosis and significant tumor reduction. Therefore, distal gastrectomy was performed. Histological examination did not reveal any viable cancer cells in the stomach and lymph nodes. Thus, a Grade 3 postchemotherapeutic effect was revealed.

[Complete histological response in advanced gastric cancer with Virchow's node metastasis after chemotherapy including S-1/CDDP--report of a case].

A 63-year-old male complaining of jaundice was examined and diagnosed with advanced gastric cancer (type 3, tub 2, cT3, cN3, cH0, cM1, cStage IV), and obstructive jaundice due to lymph node metastasis. Since curative surgery was deemed not possible, we started chemotherapy with S-1+CDDP. S-1 (120 mg/day) was administered orally for 21 days, followed by CDDP (60 mg/m2) div on day 8. After the 9th course, a significant tumor reduction was obtained. Total gastrectomy and lymph node resection (D1) were performed. The histological diagnosis revealed complete disappearance of cancer cells in both the main tumor and lymph nodes. Herein we report this rare case with a view of the literature.

[A case of adenosquamous gastric carcinoma successfully treated with TS-1, low-dose CDDP and docetaxel as neoadjuvant chemotherapy].

The patient was a 66-year-old male with extremely advanced gastric cancer type 3 and diagnosed with adenocarcinoma by endoscopic biopsies specimens. Combined chemotherapy of TS-1, CDDP and docetaxel was prescribed in order for tumor reduction and downstaging. TS-1 (80 mg/m(2)) was administered 28 days followed by 14 days rest as one course. CDDP (8 mg/m(2)) was administered on days 1, 2, 14 and 15 and docetaxel (40 mg/m(2)) was administered on day 1 and 14, followed by 4 weeks rest as one course. After 2 courses of treatment, a CT scan revealed a minor response of tumor reduction. Therefore, total gastrectomy, partial pancreas body and tail resection, and D 2 lymph node dissection were performed. The patient had undergone adjuvant chemotherapy of TS-1 and biweekly docetaxel after surgery with no recurrence for 13 months. Adverse reactions were grade 3 neutropenia and grade 2 diarrhea. Combined chemotherapy of TS-1, low-dose CDDP and docetaxel were intensive and required constant patient monitoring. However, it proved effective and feasible as a neoadjuvant chemotherapy regimen for advanced gastric cancer.

Fulminant varicella infection complicated with acute respiratory distress syndrome, and disseminated intravascular coagulation in an immunocompetent young adult.

Primary varicella infection in immunocompetent adults is very rare, but it has a high mortality rate because of serious complications. We describe a case of varicella infection in a previously healthy young adult complicated with acute respiratory distress syndrome (ARDS), rhabdomyolysis, acute hepatitis and disseminated intravascular coagulation (DIC). Acyclovir was administered for varicella infection and the ARDS was successfully treated with steroidpulse therapy, hemofiltration and a mechanical respiratory support with a positive end-expiratory pressure. Early administration of antiviral agents and extensive management were thought to be necessary for such patients with severe complications.

Tuberculous peritonitis.

We report a case of tuberculous peritonitis in a 24-year-old male patient. On admission, he was complaining of abdominal fullness and fever. Ultrasound tomography and computed tomography (CT) scan of the abdomen showed massive ascites with multiple septa. The most interesting feature of this case was the diffuse and intense uptake of gallium-67 in the abdomen. Though the initial chest X-ray showed only slight bilateral pleural effusion, and cultures from ascites, stool, sputum, and pleural effusion were negative for Mycobacterium tuberculosis, CT scan of the lung showed a small consolidation shadow with contractile change, similar to tuberculosis. A few days after the CT scan of the lung, the sputum was positive for Mycobacterium tuberculosis. Finally we diagnosed active tuberculous peritonitis, and then started antituberculous therapy. In patients with massive ascites and fever of unknown origin, tuberculous peritonitis must be considered. Gallium-67 scintigraphy has been shown to be useful when there is a high index of suspicion of tuberculous peritonitis.