Perioperative use of IEEF caused a significant increase in the total lymphocyte count at 3 and 5 days after operation and caused a shift toward B cell proliferation, which may possibly be beneficial to decrease the incidence of postoperative infectious complications.
A number of enzymes have been shown to be involved in the process of activation and/or degradation of 5-fluorouracil (5-FU), and are potential candidates for predicting chemosensitivity to 5-FU. Among these, orotate phosphoribosyltransferase (OPRT EC 2.4.2.10) is a key enzyme related to the first-step activation process of 5-FU and has been shown to be an important enzyme that helps to predict sensitivity to 5-FU and its related derivatives. We developed a new enzyme-linked immunosorbent assay (ELISA) to accurately assess intratumoral activity of OPRT. A new sandwich ELISA was established using anti-OPRT polyclonal antibodies obtained from the rabbit immunized with the recombinant human peptides of the OPRT molecule. OPRT levels were measured in eight human cancer xenografts and in 75 gastric cancer tissues using both a newly established ELISA and a conventional enzyme assay, using radiolabeled 5-FU as a substrate. There was a significant correlation between OPRT levels measured by this ELISA and OPRT enzyme activity the in eight human cancer xenografts (r 2 = 0.782) and gastric carcinoma tissue (r 2 = 0.617). The ELISA system for OPRT requires a minimal amount of carcinoma tissue, making it an easy-to-use assay system to predict sensitivity to 5-FU and its derivatives in gastric carcinoma. There was a significant correlation between tumor growth inhibition rates against the oral administration of oral-uracil/tegafur (UFT) and OPRT enzyme activity in the human cancer xenografts (r 2 = 0.574). These results suggest that this newly developed sandwich ELISA system for the quantification of OPRT levels is technically simple, feasible and a useful tool to predict sensitivity to fluoropyrimidine-based anticancer chemotherapy in patients with gastric carcinoma and other cancers. A lthough 5-fluorouracil (5-FU) and its derivatives have been important anticancer agents and have been widely applied for patients with advanced gastrointestinal cancers, the overall response rate of 5-FU alone is still at best 10 -20% for gastric carcinoma.(1) Mechanisms of the anticancer effect, metabolic pathway and the enzymes involved in the metabolic process of 5-FU have been studied extensively (Fig. 1). A variety of attempts have been made to enhance anticancer effects and to reduce toxic effects by modulating enzymes involved in the metabolic pathway of 5-FU.(2) Some of the enzymes involved in the metabolic process of 5-FU, including thymidylate synthase and dihydropyrimidine dehydrogenase, have been shown to predict sensitivity to 5-FU and/or prognosis. (3,4) Based on the fact that the inhibitor of dihydropyrimidine dehydrogenase (DPD) has been shown to enhance the anticancer effects of 5-FU, (2) DPD-inhibitory fluoropyrimidines (DIF) have been developed to enhance anticancer effects.(2) To date, DIFs have played a major role in neoadjuvant and/or adjuvant chemotherapy for patients with advanced gastric carcinoma. (5) 5-FU administered in vivo is taken up by cancer cells and is phosphorylated to 5-fluorouridine-5′-monophosphate (FUMP...
We report a case of abdominal wall abscess caused by diverticulitis of the jejunum penetrating through the abdominal wall. A 53-year-old Japanese woman visited a local hospital complaining of abdominal pain and a mass in the left lower abdomen. An abdominal computed tomography scan showed a tumor with isodensity in the left lower abdominal wall. Magnetic resonance imaging showed a mass in the abdominal wall with isointensity in the T1-intensified image and high intensity in the T2-intensified images. The mass was heterogeneous inside and protruded partially toward the intraperitoneal cavity. Ultrasound examination showed a heteroechoic mass extending into the intraperitoneal cavity. Laparotomy revealed a tumor in the abdominal wall with a fistulous tract extending to the jejunum. We resected the abdominal wall tumor with partial resection of the small intestine. The resected specimen contained a tumor with a fistulous tract passing through the abdominal wall. Histological examination revealed remarkable infiltration of neutrophils and a bacterial mass in the abdominal wall tumor, with a fistulous tract connected to the area adjacent to the mesenteric border of the jejunum. These findings suggested that diverticulitis of the jejunum had penetrated through the abdominal wall, leading to the formation of an abscess. We report this case to highlight the need for complete gastrointestinal evaluation with gastrointestinal barium studies and imaging analysis to examine extension of intra-abdominal lesions in patients with an unexplained abdominal wall abscess.
toneal dissemination is the type of recurrence that most frequently occurs in gastric carcinoma, and it is extremely difficult to deal with [1]. Longterm survival of patients with peritoneal dissemination is desperately awaited, as the mean survival at present is less than 6 months [1]. Although anticancer chemotherapy is the primary treatment available for the majority of patients with diffuse peritoneal metastasis, response to anticancer chemotherapy is extremely poor. In particular, for the majority of the patients with peritoneal recurrence, first-line anticancer chemotherapy has already been given when they were in an advanced stage before the time of operation, and following the operation, and recurrence then appears as a consequence of resistance to the first-line anticancer chemotherapy. Nonetheless, anticancer chemotherapy appears to provide a significant survival advantage over best supportive care [2]. However, no effective second-line chemotherapy has yet been available for gastric cancer patients who have not responded to or who have relapsed after an initial response to first-line chemotherapy. Therefore, an effective second-line anticancer chemotherapy regimen is expected for the treatment of recurrent peritoneal dissemination of gastric carcinomas.We report herein a patient with rectal stenosis caused by the peritoneal dissemination of recurrent gastric carcinoma resected 8 years previously. Repeated weekly administration of paclitaxel has been effective for more than 13 months. The patient is considered to be in a state of tumor dormancy of recurrent gastric carcinoma. Case reportA 66-year-old Japanese woman was admitted to our hospital with complaints of abdominal pain, loose stools, and frequent bowel movements. The patient had undergone total gastrectomy associated with D3 lymph node dissection and Roux-en-Y reconstruction AbstractWe report a patient with rectal stenosis caused by peritoneal recurrence 8 years after a curative resection of advanced stage gastric carcinoma; the recurrence was effectively treated with the weekly administration of paclitaxel. The patient was a 66-year-old Japanese woman who was admitted to our hospital complaining of abdominal pain and frequent bowel movements. She had undergone total gastrectomy, due to advanced-stage gastric carcinoma with extensive lymph node metastasis, 8 years before, and had taken an oral anticancer agent, fluoropyrimidine, for 4 years after the operation. Colonofiberscopy performed on admission revealed circumferential rectal stenosis located 10 cm from the anal verge. Barium enema study demonstrated extensive poor expansion of the upper and lower rectum and irregularity of the descending colon. Abdominal computed tomography (CT) scanning revealed wall thickening in the rectum and descending colon. These findings were compatible with rectal stenosis caused by the peritoneal recurrence of gastric carcinoma. Weekly administration of paclitaxel was started. The abdominal symptoms soon disappeared when the second cycle of paclitaxel was compl...
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