Patients with gastrointestinal tract disorders receiving parenteral nutrition need a higher dose of vitamin C.

BACKGROUND/AIMS: Appropriateness of the vitamin doses in Japanese commercial multi-vitamin preparations for parenteral nutrition therapy was investigated in patients with gastrointestinal tract disorder by evaluating the vitamin status (blood concentrations and urinary excretions of vitamins B1, B2, B6, and C) of them. METHODOLOGY: Commercial multivitamin preparations were administered continuously with a commercial PN solution over 5 days to 10 patients with gastrointestinal tract disorder. Blood concentrations of vitamins B1, B2, B6, and C were measured on the mornings of day 1, day 4, and day 6. Urinary excretions were measured in 24-h urine collections collected after day 3 and after day 5. RESULTS: Blood concentrations of vitamins B1, B2, and B6 increased but remained within or slightly above the normal throughout the study, and urinary excretion values were normal in all patients. However, blood vitamin C concentration surpassed the lower limit of normal (5.5 microg/mL) only on day 6. Urinary vitamin C excretion was below normal (20.0 mg/day) in all and 7 patients on days 3 and 5, respectively. CONCLUSIONS: In patients with gastrointestinal tract disorder, the doses of vitamins B1, B2, and B6 of Japanese commercial multi-vitamin preparations are adequate but that of vitamin C (100 mg/day) is inadequate and should be increased.

[A case of ruptured hepatocellular carcinoma originated from nonalcoholic steatohepatitis (NASH)].

A 69-year-old woman visited our emergency room because of sudden right lower quadrant abdominal pain. Abdominal CT revealed a ruptured tumor in the anterior segment of the liver. Emergency laparotomy was selected due to interventional radiology was not available. As the patient was in shock status with massive intraabdominal hemorrhage, ligation of the right hepatic artery and suturing of the tumor bleeding point was carried out. Given the patient's history and liver biopsy report, we concluded as hepatocellular carcinoma derived form NASH. Anterior resection of the liver was performed after the patient became stable. About one year later, tumor was detected in the lateral segment and was removed. The patient is free of disease for two and a half years after the initial operation. Carcinogenesis of the hepatocellular carcinoma within NASH is not well described. We herein report a case of ruptured hepatocellular carcinoma originated from NASH.

[A case of hepatocellular carcinoma with advanced gastric cancer treated by radio frequency ablation].

A 69-year-old male patient has been diagnosed hepatitis B a couple of years ago at our hospital. His follow up CT revealed multiple hepatocellular carcinomas (HCCs) in May 2007. Transarterialchemoembolization was selected for treatment. A couple of months later, carcinoma in segment eight was diagnosed viable by CT. Radiofrequency ablation (RFA) therapy was performed for further treatment but was incomplete. On the other hand, gastric cancer was discovered at the same time. Total gastrectomy with regional lymph node dissection and splenectomy were performed. Pathological examination of the dissected lymph nodes revealed not only the metastases of the gastric cancer but also HCC. Recently, RFA treatment is growing in number for HCC. Although lymph node metastases in HCC are seldom seen, our case suggests that RFA may have led to the unexpected metastases to the lymph nodes.

[A case of adenosquamous carcinoma of the liver].

A 60-year-old man underwent abdominal computed tomography due to the chest pressure. Then, a 10 cm sized tumor in the right lobe of the liver was detected. Tumor marker was normal except that CA19-9 was as high as 703 U/mL. We diagnosed as the CCC and performed PTPE, and then, we performed right hepatectomy and adrenal deprivation, and partial resection of the diaphragm and IVC. Pathological diagnosis of the resected specimen was adenosquamous carcinoma of the liver. Metastasis to the costal bone was detected after the operation, and irradiation was performed. Now, S-1/GEM therapy as adjuvant chemotherapy is administered. Adenosquamous carcinoma of the liver is very rare and its prognosis is very poor due to local recurrence and metastasis to the lymph node. Adjuvant therapy is necessary but a unified guideline is not determined.

[A case of locally recurrent rectal cancer responding to radiation and chemotherapy with S-1].

We describe a case of locally recurrent rectal cancer that was successfully treated with radiation and chemotherapy with S-1; this treatment resulted in long-term survival of the patient with a good performance status. A 51-year-old man underwent Hartmann's operation for advanced rectal cancer. At 6 months after the surgery, a pelvic computed tomography (CT) scan showed a local recurrence of the rectal cancer. The patient's serum CA19-9 level had increased to 3,200 U/mL. The tumor was unresectable, so that radiation therapy was administered to the pelvic region at a total dose of 56 Gy, followed by oral chemotherapy with S-1 for 2 years. After these treatments, the serum CA19-9 level returned to normal. No signs of tumor recurrence were observed as of 3 years and 5 months after the confirmation of local recurrence. A combination of radiation therapy and oral administration of S-1 could be a useful treatment for unresectable locally recurrent rectal cancer.

[Adjuvant chemotherapy of S-1 and CDDP for undifferentiated adenocarcinoma of the stomach].

A 67-year-old female visited our department complaining a general fatigue. Gastrointestinal endoscopy revealed a giant ulcer at distal portion of the stomach. NSE was the only tumor marker showing an abnormal value. Pathohistology of the biopsy specimen showed a monotonus massive growth of small irregular tumor cells. Distal gastrectomy with regional lymph node dissection was carried out. Final pathology report was undifferentiated adenocarcinoma of the stomach, exposing itself to serosa with lymph node metastasis. Postoperative chemotherapy was started using S-1. However, despite NSE turning normal, CEA rose that CDDP was added to the regimen. She went into remission for several months but CEA rose again and CDDP was changed to CPT-11. To our great regret, she died six months after the operation. Undifferentiated adenocarcinoma of the stomach is rare disease. Immunohistochemical staining is useful for a differential diagnosis. Prognosis is said to be poor but S-1/CDDP may contribute to prolong prognosis.