Search

Patient: Male, 57-year-old Final Diagnosis: Febrile neutropenia Symptoms: Fever Medication: Nivolumab Clinical Procedure: Chemotherapy Specialty: Oncology Objective: Adverse events of drug therapy Background: Nivolumab is a human IgG4 monoclonal antibody against human programmed cell death 1 (PD-1). It has demonstrated efficacy against metastatic non-small cell lung cancer (NSCLC). Treatment with nivolumab is sometimes associated with immune-related adverse events (ir AEs) in patients. These specific ir AEs include pneumonitis, hypothyroidism, dermatitis, enterocolitis, hepatitis, and neuropathy. However, hematological toxicity is rare. Case Report: A 57-year-old man with lung adenocarcinoma, with brain and adrenal gland metastases, was therefore started on nivolumab therapy as third-line treatment. After administration of the second dose with nivolumab, grade 3 febrile neutropenia (FN) and grade 2 liver dysfunction developed in the patient. The patient was started to on intravenous antibiotics, granulocyte colony-stimulating factor (G-CSF), and corticosteroids. Neutrophil counts and liver function gradually improved, and corticosteroids were tapered over 6 weeks. However, the patient was re-treated with G-CSF because the neutrophil counts decreased again. Conclusions: Care needs to be taken with such patients because neutropenia due to treatment with nivolumab can recur, as well as other ir AEs.

SUMMARY. Immunosuppressive acidic protein (IAP) suppresses several immune responses in vivo and in vitro , and high preoperative IAP levels could predict the impairment of the host's immunity. In this study prognostic significance of preoperative IAP levels was investigated in 68 esophageal cancer patients with curative resection and eight with non-curative resection. The curative group had significantly lower levels than the non-curative group (432 ± 183 mg/mL vs. 739 ± 235 mg/mL, P < 0.0001). The IAP levels were associated with T-status (P < 0.0001), lymphatic invasion (P < 0.05), and p-stages (P < 0.0001). When 5-year survival rate of patients with curative resection was compared by setting various cutoff values of IAP between high and low IAP groups, several cutoff points (400-580 mg/mL) were revealed to be significantly associated with survival. Setting cutoff value of IAP to 560 mg/mL resulted in a most significant difference of 5-year survival rate of patients between the high and low IAP groups (13.9% and 61.5%, P < 0.0001). These data indicate that pre-operative IAP level is a useful parameter to predict the prognosis of esophageal cancer patients after curative resection.

症例は72歳,男性. 2日前から持続する腹痛および嘔吐を主訴に当院受診.血液検査にて貧血を認め,腹部造影CT検査では腸間膜血腫および腹腔内出血が疑われた.腹部外傷の既往は認めなかった.同日は全身状態が安定していたため経過観察入院とした.翌日,貧血の進行を認め,腹部血管造影検査を施行した.中結腸動脈左枝に狭窄・蛇行・造影剤の血管外漏出を認めたため,腸間膜血腫の診断にて同日緊急手術を施行した.横行結腸間膜内に手拳大の血腫を認め,中結腸動脈左枝に広汎な血栓を認めた.動脈性に出血していた中結腸動脈左枝の辺縁動脈を止血し,横行結腸切除を施行した.病理組織学的検査にて中結腸動脈左枝の辺縁動脈に連続した血栓を認めた.術後精査にて抗カルジオリピン抗体が2回陽性となり,抗リン脂質抗体症候群に合併した腸間膜血腫と診断された.現在,血栓症の再発予防としてアスピリンを内服中であるが,再発を認めていない.

To evaluate intestinal motility after 80% massive distal small bowel resection (MSBR), we continuously monitored interdigestive and postprandial bowel motility using bipolar electrodes and/or contractile strain gage force transducers in conscious beagle dogs before, and at 0-4 weeks and 8-13 months after the surgery. Fasting duodenal migrating myoelectric (or motor) complexes (MMCs) occurred at longer intervals in the short-term after 80% MSBR than in controls, and were simulated in long-term that in controls. MMCs arising from the duodenum were often migrated to the proximal jejunum, the jejunum above the anastomosis, and to the terminal ileum beyond the anastomosis. The velocity of duodenal MMC propagation was slowed in every intestinal segment in the short-term, and had not recovered even long after the operation. The duration of the postprandial period without duodenal MMCs was prolonged significantly in the short-term, and still remained longer in the long-term than in controls. These findings suggest that changes in gut motility after MSBR tend to compensate for the shorter intestine and maintain small bowel absorption early postoperatively, and adaptations of motility would occur over the long-term to increased intestinal absorption.

To evaluate the functioning and effectiveness of a 20-cm reversed jejunal segment after 75-80% massive small bowel resection (MSBR), and whether migrating polarity changes or not, we continuously measured the postoperative bowel motility (using bipolar electrodes and/or contractile strain gage force transducers) in interdigestive and postprandial conscious dogs in short- (2-5 weeks) and long-term (6-10 months) after surgery. The fasting migrating myoelectric (or motor) complex (MMC) arising from the duodenum was often interrupted at the jejunum above the proximal anastomosis and did not migrate smoothly to the reversed segment or terminal ileum. In addition, brief small discordant contractions were frequent in the jejunum above the proximal anastomosis and the proximal part of the reversed segment. The duodenal MMCs predominantly propagated to the ileum through the inherent anatomic continuity of the bowel. These findings of the MMC propagation pattern are very similar in short- and in long-term after surgery. The duration of the postprandial period without duodenal MMC activity was markedly longer in short-term, but shorter in long-term (both were significantly longer than in controls). Marked dilatation of the jejunum and reversed jejunal segment was noted across the proximal anastomosis. These results suggest that the transit time and passage of intestinal contents can be delayed and stagnated for at least 10 months after MSBR with a 20-cm reversed jejunal segment. Although, reports on the polarity of peristalsis in the reversed segment in long-term followup have been contradictory in both experimental and clinical studies, this results support the conclusion that the reversed jejunal segment maintains its inherent propagative polarity and pattern over a long postoperative period.

Electrogastrography (EGG) measures the myoelectric and motor activity of the stomach as detected by cutaneous electrodes attached to the epigastrium. The specific frequency of gastric activity is thought to be 3 cycles per minute (cpm) as determined by spectral analysis. EGG was performed to evaluate gastric motor function in 13 patients (mean age 11.6 ± 2.90 years) who had undergone operative repair of a gastric rupture. The EGG results were compared with those of 8 normal, age-matched controls (mean age 9.25 ± 2.14 years). The mean frequency (MSF) (2.84 ± 0.067 cpm) of the postprandial EGG spectra of 5 patients with ruptures at or along the greater curvature was significantly lower (P

To evaluate the long-term function and effective motility of a reversed jejunal segment after extensive small bowel resection, the authors continuously measured postoperative bowel motility during interdigestive and postprandial periods in conscious dogs 6 to 10 months after surgery. The long-term findings were compared with previously reported short-term results measured 2 to 4 weeks after the operation. In the long-term follow-up dogs with a 20-cm reversed jejunal segment constructed after extensive (75% to 80%) small bowel resection, the fasting duodenal migrating myoelectric (or motor) complex (MMC) was often interrupted in the jejunum above the reversed segment, and did not migrate smoothly to the reversed segment or terminal ileum. The MMCs arising from the duodenum predominantly propagated to the ileum through the inherent anatomic continuity of the bowel. In addition, brief small discordant contractions were frequent in the reversed segment and the jejunum, above the proximal anastomosis. These findings are similar to those of the MMC propagation pattern noted 2 to 4 weeks after surgery. However, the postprandial duration without duodenal MMC activity was significantly shorter in the dogs with long-term follow-up than in those with short-term follow-up (both were longer than in control dogs). Marked dilatation of the jejunum and reversed jejunal segment was noted across the proximal anastomosis. These results suggest that the transit time and passage of intestinal contents can be delayed and stagnated for at least 10 months after extensive small bowel resection with a 20-cm reversed jejunal segment. Although reports on the polarity of peristalsis in the reversed segment in long-term follow-up have been contradictory in both experimental and clinical studies, this research supports the conclusion that the reversed jejunal segment maintains its inherent propagative polarity and pattern over a long postoperative period.

The introduction of mass screening (MS) has increased the number of patients who have been detected in the early clinical stages as well as the total number of patients who have been detected with neuroblastoma (NB). We investigated the problems of MS by DNA content analysis of NB in 89 patients treated at Niigata University Hospital. Surgical materials were available for 73 of the 89 patients. Of the 27 patients who received MS, 16 NBs were detected and 11 were not. The numbers of patients in the early clinical stages (I, II) were 7 (15.2%) before the introduction of MS an 10 (37.0%) thereafter (P

To clarify the postnatal developmental changes of the motor activity of the gastrointestinal tract, the frequency and amplitude of spontaneous intraluminal pressure of the isolated stomach, duodenum, jejunum, and ileum of the 1- to 5-week-old rat and adult (over 12 weeks old) were examined in vitro. The spectral frequencies of the spontaneous motor activity of 1- to 2-week-old rat were significantly lower than those of the adult. They became similar to the values of the adult at 3-4 weeks after birth. The amplitudes of spontaneous motor activity of 1- to 3-week-old rats were significantly smaller than those of adults. They became similar to the values of adults at 4 weeks after birth. Body weight, stomach wet weight and the length of the total intestine increased gradually and they were still below the values of the adult even at 5 weeks after birth. The stomach was filled with just milk until the end of 2 weeks. However, by the end of 3-4 weeks, milk and solid food were found in the stomach. By the end of 5 weeks, just solid food was seen in the stomach. Therefore, the motor activity of the gastrointestinal tract at birth seems immature and gradually develops postnatally. It seems to be mature by the end of 3-4 weeks after birth. Interestingly, the time of the pacemaker or motor maturity of the gastrointestinal tract according to spontaneous frequency or pacemaker activity and amplitude seemed almost consistent with the weaning time.

To evaluate the functioning and effectiveness of a reversed jejunal segment after extensive small bowel resection, we continuously measured the postoperative bowel motility (using bipolar electrodes and/or contractile strain gage force transducers) in interdigestive and postprandial conscious dogs at 2 to 5 weeks after surgery. The fasting duodenal migrating myoelectric (or motor) complex (MMC) occurred at markedly longer intervals in dogs with a 20-cm reversed jejunal segment created after 75% to 80% extensive small bowel resection (group 3) than in dogs that received extensive resection alone (group 2) or dogs that underwent construction of a reversed jejunal segment without bowel resection (group 1). The MMC arising from the duodenum was often interrupted at the jejunum above the proximal anastomosis and did not migrate smoothly to the reversed segment or terminal ileum in group 3. In addition, brief small discordant contractions were frequent in the reversed segment and the jejunum above the proximal anastomosis in group 3. The duration of the postprandial period without duodenal MMC activity was significantly prolonged in groups 2 and 3. These results suggest that the transit time and passage of intestinal contents were delayed and that the periodical MMC was disturbed in group 3. The delay of transit time was due to prolongation of the interval between duodenal MMCs, the interruption of MMC propagation at the jejunum above the proximal anastomosis, the dominance of MMCs that followed the inherent anatomical continuity of the bowel, and discordant movements across the proximal anastomosis. Functional obstruction could be a potential problem in a 20-cm reversed jejunal segment inserted after extensive small bowel resection.

4143 Background: Five-fluorouracil (5-FU) is still one of the key-drug for chemotherapy in gastric and colorectal cancer. Therefore, prediction of 5-FU sensitivity is of great importance for chemot...

4200 Background: We had previously reported that peritoneal micrometastasis determined by CEA mRNA level in peritoneal washings using real-time quantitative RT-PCR (RQ-PCR) is a good predictor for ...