[Second-line FOLFIRI plus bevacizumab for patients with metastatic colorectal cancer after resection of the primary lesion].

The efficacy and safety of bevacizumab(BV), combined with infusional 5-fluorouracil/leucovorin(5-FU/LV)plus irinotecan(FOLFIRI)as the second-line treatment for metastatic colorectal cancer(mCRC)after resection of the primary lesion, have not been fully clarified. We examined clinical results of 35 patients on BV plus FOLFIRI at our hospital, and investigated the efficacy of BV plus FOLFIRI in mCRC patients who failed oxaliplatin-containing regimens(26 patients were treated with BV at a dose of 5mg/kg, 3 patients with BV 10mg/kg, and 6 patients had BV increased from 5mg/kg to 10mg/kg). The average frequency of BV plus FOLFIRI treatment was 13. 9 times, and the average length of treatment was 10. 0 months. The overall response rate was 17. 1%(CR 1 patient, PR 5 patients, SD 21 patients, PD 8 patients). The median PFS was 11. 0 months for FOLFIRI plus BV after first-line chemotherapy, and the median OS was 23. 0 months. The adverse events were 77. 1%(>Grade 3, 55. 5%)and the BV-associated adverse event was grade 3 hypertension(2 patients). The FOLFIRI plus BV regimen is an active and well-tolerated second-line chemotherapy treatment for patients with mCRC after resection of the primary lesion.

Perioperative management of continuous ambulatory peritoneal dialysis patients undergoing inguinal hernia surgery.

Management of patients undergoing dialysis after inguinal hernia surgery has not been standardized. This report presents the results of 9 patients with inguinal hernias (11 hernias) who were undergoing continuous ambulatory peritoneal dialysis (CAPD). All patients treated in this hospital since 2007 have returned to CAPD within 3 days after surgery without switching to hemodialysis (HD). The mean durations for resuming CAPD after surgery were 7.6 days from 1998 through 2007 and 2.3 days since 2008. The surgical procedure was performed with a polypropylene mesh in all cases. Local anesthesia was utilized for one patient with low cardiac function. All patients recovered rapidly, with no uremia or dialysis-related complications. No leakage or hernia recurrence was observed over the subsequent observation period (56.2 months). This experience suggests the possibility that interim HD can therefore be skipped in patients undergoing CAPD if the hernia sacs are closed tightly. Local anesthesia seems to be safe for high-risk hernia patients undergoing CAPD.

Immunologic mechanisms in tolerance produced in mice with nonradiation-based lymphoablation and donor-specific bone marrow.

BACKGROUND: These experiments evaluate the mechanisms associated with tolerance in mice treated with sirolimus, antilymphocyte serum (ALS), and donor-specific bone marrow (BM). METHODS: Tolerance to fully MHC-incompatible skin allografts was induced as follows: C57Bl/10 (H2b) recipients received 0.5 mL of rabbit anti-mouse polyclonal ALS on days -1, +2, and +5 relative to B10.A (H2k) donor skin grafting on day 0. Sirolimus was given in a single dose (24 mg/kg intraperitoneally) on day 6. Freshly harvested B10.A (H2k) donor-specific BM was administered at a dose of 25 x 10(6) (ALS/BM25/sirolimus) or 150 x 10(6) (ALS/BM150/sirolimus) cells intravenously on day 7. Skin allograft survival was correlated with the recipient's immunologic status. Recipients were assayed for suppressor cell activity (mixed lymphocyte coculture assays), clonal deletion (T-cell receptor Vbeta11 assay), peripheral and thymic chimerism (flow cytometry and reverse transcriptase polymerase chain reaction), and anergy (response to exogenous interleukin 2). RESULTS: Mice treated with ALS/BM25/sirolimus showed specifically prolonged but not indefinite allograft survival (median survival time 116 days). Allograft survival correlated with donor-specific clonal deletion and the presence of donor class II mRNA in the recipient's thymus. Mice given the ALS/BM150/sirolimus protocol showed indefinite donor-specific tolerance. Tolerance could not be broken with the administration of high doses of interleukin 2. Splenocytes taken from mice 14 days after tolerance induction inhibited donor-specific and third-party mixed lymphocyte culture proliferation in a dose-dependent fashion. This suppression could be ablated by depleting splenocytes of cells of donor origin before use in coculture. Clonal deletion was detectable 30 days after tolerance induction in mice treated with ALS/BM150/sirolimus and was maintained indefinitely. CONCLUSION: Induction of tolerance by ALS, BM, and sirolimus results in a state of donor-specific tolerance, and multilineage chimerism evolves that is permanent and associated with clonal deletion of alloreactive T cells.