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We report the long-term survival of a patient with metastatic hepatocellular carcinoma (HCC), successfully treated with transcatheter arterial chemoembolization (TACE)/hepatic arterial infusion chemotherapy (HAIC) combined with long-term administration of sorafenib. A 74-year-old man underwent hepatectomy for a huge hepatocellular carcinoma, measuring 19 × 13 cm. Multiple intrahepatic HCCs that recurred 5 months post-surgery were treated with TACE. After 3 cycles of TACE, however, sorafenib was administered to treat progressive disease. Six months after sorafenib treatment, TACE combined with sorafenib was administered for treatment of refractory intrahepatic lesions. Following further disease progression, TACE was replaced by up to 11 rounds of HAIC. We report successfully treatment of refractory metastatic HCC with sorafenib for more than 30 months along with a review of the literature.

A 48-year-old man underwent subtotal esophagectomy for pStage III (pT 3 pN 3) thoracic esophageal carcinoma on June 20, 2002, in combination with chemotherapy (5-FU 500 mg/day day 1-14, CDDP 10 mg/day day 1-14, VDS 3 mg on days 1 and 8) before and after the operation. Recurrence was seen 7 months after the operation in right pleura and lower mediastinum. Chemo (same regimen)-radiotherapy (50 Gy) was then performed but without effect. Thereafter, lung and upper mediastinal metastases were found, and weekly administration of paclitaxel (70 mg/m2, day 1, 8, 15, q 4w) was initiated in combination with radiotherapy (40 Gy). Two cycles of treatment resulted in PR, and CR was achieved after the 8th cycle was completed. Although treatment was terminated after the 12 th cycle due to development of peripheral neuropathy (grade 2), CR was still maintained 8 months after the completion of treatment. These results suggested the effectiveness of the treatment in cases that show resistance to conventional 5-FU-based chemotherapy.

A 78-year-old woman was admitted to our hospital after computed tomography (CT) had revealed in her the presence of a giant ascending aorta-arch aneurysm. This aneurysm was about 8 cm in diameter and associated with DeBakey type II dissection. Aortography showed the same condition as the CT view with the entry on the ascending aorta. The ascending aortaarch was replaced with a Hemashield 24 mm, by using deep-hypothermic selective cerebral perfusion and the open distal method. There were no complications during her peripostoperative state and no evidence of leakage and remnant dissection on CT and aortography. This is a rare case in which thoracic aortic aneurysm coexisted with dissection. In this case of severe atherosclerosis, deep-hypothermic selective cerebral perfusion and the open distal method provided effective treatment.

A 54-year-old man suffering from Borrmann type 4 advanced gastric cancer with pancreatic invasion and paraaortic lymph node metastases underwent a total gastrectomy, which was a radical C operation. From postoperative month 4, he visited our hospital with multiple liver metastases and increased lymph node metastases. After chemotherapy with CDDP and 5-FU, CDDP and UFT was administered on an outpatient basis. The effect of this therapy was PD, therefore, docetaxel and 5'-DFUR combination chemotherapy was performed as second line therapy. After 2 courses of this therapy, the size of liver and lymph node metastases was reduced and the effect of this therapy was PR. The patient has undergone 4 courses of this therapy and is maintaining a clinical PR. It is conceivable that docetaxel and 5'-DFUR combination chemotherapy is useful for patients with advanced and recurrent gastric cancer, even if they had been treated with 5-FU administration as first line therapy.

The activity and toxicity of a weekly infusion of low-dose paclitaxel was studied. Twelve patients with metastatic or advanced breast cancer received paclitaxel (80 mg/m2 over 1 h) every week. Administration was continued for 6 weeks with two weeks rest until disease progression or limiting toxicity. Dexamethasone 20 mg, diphenhydramine 50 mg, and ranitidine 50 mg were given prior to each dose of paclitaxel. Six patients had received prior standard CMF therapy, and four patients had received CMF and docetaxel therapy. Two patients had not received prior therapy. The overall response rate was 58% with 17% complete responses and 42% partial responses. Responses were observed in both patients without prior therapy, and in five of 10 (50%) with prior therapy. Grade 3/4 neutropenia occurred in one patient; febrile neutropenia was not observed. There was no neuropathy or hypersensitivity. Weekly paclitaxel is active and well tolerated in patients with metastatic or advanced breast cancer. This schedule allows a high cumulative dose of paclitaxel without major myelo- or neurotoxicity. This weekly regimen deserves further exploration.

We measured pyrimidine nucleoside phosphorylase (PyNPase), a known angiogenetic factor, and dihydropyrimidine dehydrogenase (DPD) in advanced gastric cancers. PyNPase was expressed in cytoplasm of the cancer cells and surrounding interstitial cells. The levels of PyNPase and DPD were significantly higher in cancer tissue. With respect to tumor factors, the level of PyNPase was significantly higher in cases positive for venous invasion. We divided patients into two groups, with high and low activities of IAP and MMP-9. The level of PyNPase was significantly higher in the high IAP activity group. A correlation was suggested between the level of PyNPase and the activity of IAP. 5'-Deoxy-5-fluorouridine (5'-DFUR) is transformed into 5-FU by PyNPase and manifests antitumor effects. DPD is a rate-limiting enzyme in the process of degradation of 5-FU. In the present study, the level of PyNPase/DPD was significantly higher in cancer tissue. PyNPase/DPD suggests not only the malignant potential of the tumor but also the efficiency of chemotherapy using 5-FU, especially 5'-DFUR.

Pulmonary resection of metastatic lesions from colorectal cancer was performed in 19 patients. The cumulative 5-year survival after thoracotomy was 39%. Patients with either one or two metastases has a significantly better survival, with a 5-year survival of 55%, than did those with a greater degree of metastases. Other factors had no apparent influence on postthoracotomy survival. Therefore, the number of metastases should be carefully considered when pulmonary resection is considered for metastatic colorectal cancer.

A 71-year-old male with recurrent colon cancer was admitted to our hospital with obstructive jaundice. Virchow's node metastasis was palpable in his neck. The enlarged intraabdominal lymphnodes due to recurrence and liver metastasis were demonstrated on computed tomography. Bile duct obstruction was treated by expandable metallic biliary endoprosthesis. 5'-DFUR (5'-deoxy-5-fluorouridine) was administered orally at 600 mg daily. Virchow's node metastasis completely disappeared by 46 days after administration of 5'-DFUR. The enlarged intraabdominal lymphnodes and liver metastasis disappeared on computed tomography. No significant side effects from 5'-DFUR were encountered for 18 months. 5'-DFUR appears to be a useful and safe treatment for recurrent colon cancer.

A 61-year-old man was admitted to our hospital because of a left lung cancer. The chest x-ray film showed an irregular mass in the left upper lung field and the ill-defined left upper mediastinal border. A large portion of the aorta seen in the CT section above the aortic arch was understood to be aortic elongation. When a left pneumonectomy was performed, a saccular aneurysm of the distal aortic arch was found and resected under partial aortic clamping. Following the aneurysmectomy mediastinal dissection was performed in the normal way. The patient recovered uneventfully. The pathological specimens showed a pT2N1M0 squamous cell carcinoma with obstructive pneumonia and an arteriosclerotic aneurysm. There was no report of lung cancer associated with aneurysm of the thoracic aorta. In a patient with left lung cancer obliterating the left upper mediastinal border (the "silhouette sign") the aortic arch should be closely examined by MRI and/or angiography.

A 81-year-old man was admitted because of left recurrent pneumothorax with pleural adhesion. A drainage tube was inserted through the left lateral thoracic wall. The lung seemed to be fully expanded in the AP chest X-ray film but his dyspnea was not relieved. The CT examination showed severe medial pneumothorax. He was operated on and recovered uneventfully. It is important to note medial pneumothorax in patients in the supine position and/or with pleural adhesion.

The usefulness of preoperative administration of Doxifluridine (5'-DFUR) for treating carcinoma of the colon and rectum was studied through a determination of 5-FU concentration in carcinoma, normal intestine, serum and lymph nodes concerned. 1,200 mg/day of 5'-DFUR was administrated orally to 16 patients with carcinoma of the colon and rectum over four days before surgery, and the specimens obtained by resecting the carcinoma were subjected to the mass spectrometry using a gas chromatography to determine 5-FU concentrations. The time needed for collection of the specimen from the final administration of 5'-DFUR was 3.0 to 20.5 hours (10.7 +/- 6.6 hrs). 5-FU concentrations were as follows: 75.8 +/- 61.2 ng/g in the carcinoma, 39.9 +/- 63.5 ng/g in the normal intestine and 26.8 +/- 52.4 ng/g in the lymph nodes concerned, which were significantly high as compared to serum level of 2.3 +/- 4.9 ng/ml (p less than 0.05). Further, a high level of 90.1 +/- 29.3 ng/g (n = 6) of the carcinoma was sustained even at 12 hours or more since final administration of 5'-DFUR. In view of histological patterns, the levels were 139.5 +/- 69.5 ng/g (n = 5) in well differentiated carcinoma and 46.9 +/- 27.4 ng/g (n = 11) in moderately differentiated carcinoma, the level being significantly high in the former (p less than 0.05). A histologic therapeutical effect was shown in one out of 16 cases, with the improvement that remained the score to grade 1. This was deemed due to the small dosage and a short duration of 5'-DFUR.

A 44-year-old man who had sustained injuries to the chest and left upper extremity was admitted to our hospital. The radial pulse was not palpated at the left wrist. Angiography showed occlusion of the left subclavian artery with mediastinal hematoma. The left vertebral artery filled in a retrograde direction and the distal left subclavian artery could be visualized by filling from the left vertebral artery. He had no ischemic neurological symptom but was immediately operated on to prevent hemorrhage. Through a median sternotomy the injured portion of the left subclavian artery was removed and replaced by a dacron prosthesis. The specimen represented that the artery was completely divided and occluded with thrombus. Recovery was uneventful. This was the seventh case of traumatic subclavian steal syndrome. Vascular repair should be made soon in traumatic subclavian steal syndrome because collateral circulation is poor compared with that in arteriosclerotic obstruction.

A SU-polysaccharide skin test (SU-PS test) has been employed and studied as a parameter for monitoring the immunological status of OK-432 treated patients who had undergone a curative gastrectomy for a gastric cancer in stages II and III. The median diameter of the erythema (SU-PS value) was found to have no relation to the number of lymphocytes and the serum protein level and was depressed by combined chemotherapy. The SU-PS value was significantly higher in patients not given a splenectomy than in patients who had undergone a patients splenectomy. The spleen is considered the essential organ to focus on in OK-432 immunotherapy.