Using oral administration of 5-FU, we confirmed that the 5-days-a-week schedule allowed dose intensity escalation and was superior to the daily schedule in both enhancement of antitumor effect and protection against adverse effects.
The DNA ploidy and DNA indices (DI) of 414 patients with colorectal cancer were analyzed, and the incidence of patients with metachronous liver metastasis was found to be significantly higher in those with aneuploid tumors and a DI above 1.5 than in those with aneuploid tumors and a DI below 1.4, or in those with diploid tumors and a DI equal to 1.0. Next, to confirm the effectiveness of administering prophylactic portal infusion chemotherapy (PPIC) as adjuvant therapy for the prevention of metachronous liver metastasis in colorectal cancer, a randomized controlled trial of PPIC was performed on 110 consecutive patients with primary colorectal cancer who had undergone curative resection. Although the incidence of patients with metachronous liver metastasis in the two study groups was not significantly different at 3.3% in the PPIC group and 10.3% in the control group, the incidence in the patients with aneuploidy and a DI above 1.5 was significantly lower in the PPIC group than in the control group. These findings suggest that colorectal cancer with aneuploidy and a DI above 1.5 may have a strong tendency to metastasize to the liver, and that prophylactic portal infusion chemotherapy may be effective for preventing metachronous liver metastasis in such patients.
Among diaphragmatic hernias, relatively rare Morgagni hernia in a patient is reported, together with a review of the literature. A 71-year-old woman complained of nausea and vomiting. Chest rentogenogram, gastrointestinal series, barium enema and chest CT showed the righ-sided Morgagni hernia prolapsed with the stomach and transverse colon. Herniorrhapy was performed by abdominal approach. Two hundred and fifty-three cases of Morgagni hernia were reported in the Japanese literature until 1989, comprising of 64 males and 179 females except for 10 cases with unknown sexuality. The disease was common in an age group under 6 or over 51years old, and was predominant in females (males versus females: 1 vs. 2 and more). With respect to hernia contents, the great omentum was common and followed by the transverse colon, small intestine and liver. Only 14 cases, with had hernia contents of the stomach and transverse colon like this case, have been reported and the majority of the cases involved older females. Chest CT is useful for qualitative diagnosis when the hernia content is the great omentum.Transabdominal approach is recommended when the preoperative diagnosis can be made as Morgagni hernia.
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