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The primary modalities for management of liver abscesses are usually antibiotics and percutaneous drainage. However, in patients with ascites or bleeding tendency, the percutaneous puncture of liver abscesses may be unsuitable. We applied a new approach, nasobiliary tube drainage, for a giant pyogenic liver abscess following diagnostic endoscopic retrograde cholangiopancreatography. Pyogenic liver abscess is often biliary in origin, and this new approach includes assessment of biliary abnormality for the management of the abscess, enabling treatment of parients in whom puncture of the abscess is considered dangerous because of massive ascites around the liver. We propose that this procedure is useful in the management of a subgroup of patients with pyogenic liver abscess. To our knowledge, no previous reports of endoscopic transpapillary abscess drainage in pyogenic liver abscess are available. [ABSTRACT FROM AUTHOR]

An 88-year-old man was referred to our hospital for further examination of an asymptomatic liver tumor. MRI showed low-intensity regions on T1-weighted images, high-intensity regions on T2-weighted images, high-intensity regions on diffusion-weighted images, and low-intensity regions in the arterial, portal, and hepatocyte phases of Gd-EOB-DTPA. PET scan of the tumor was positive, while endoscopy exhibited no malignant findings. The CT and MRI findings showed that the tumor could be a metastatic liver tumor, cholangiocellular carcinoma, or hepatic inflammatory pseudotumor. Considering the possibility of a malignant tumor, laparoscopic partial hepatectomy was performed as a diagnostic treatment. The patient was discharged on the 8th postoperative day. The histopathological diagnosis was diffuse large B-cell lymphoma. Since the lesion was localized to the liver, a diagnosis of malignant lymphoma originating from the liver was made. Six courses of R-THP-COP therapy were administered. No indication of recurrence was noted 18 months after surgery. Although primary hepatic lymphoma is difficult to diagnose, laparoscopic hepatectomy allows for an accurate diagnosis and early postoperative recovery, enabling rapid administration of chemotherapy.

Subjects: Between August 2003 and January 2008, 35 patients with primary breast cancer received preoperative systemic chemotherapy(PSC)., Methods: The subjects were divided into 4 groups based on the expressions of ER, PgR, and HER2: luminal A and B, HER2, and basal-like groups. FEC75 followed by docetaxel was administered preoperatively. However, a regimen with trastuzumab was employed after 2006., Results: The subjects consisted of 1 male and 34 females, with a mean age of 56.0 years. In 65.7% of these, axillar lymph node metastasis was detected before surgery: 13 patients in the luminal A, 4 in the luminal B, 13 in the HER2, and 5 in the basal-like groups. A clinical complete response(cCR)was achieved in 25.7% of the patients, and a partial response in 62.9%; the response rate was 88.6%. Pathologically, the grade was evaluated as 3 in 14.3% of the patients and 2 in 48.6%. In the basal-like and HER2 groups, the cCR and pCR rates were higher than those in the luminal groups. Combination therapy with trastuzumab was not effective in the HER2 or luminal B group., Discussion: This simple classification method may be useful for predicting the effects of PSC.

Subjects: The subjects were patients with resectable breast cancer who visited our department between August 2003 and November 2004, did not have any other risk factors defined in the St. Gallen Consensus Conference,and were receptor-negative or had axillary lymph node metastasis., Methods: The histological type, ER, PgR, HER2, and histological grade were evaluated by needle biopsy. Four courses of CEF (5-FU: 500 mg/m(2)+EPI: 75 mg/m(2)+CPA: 500 mg/m(2)) were performed at 3-week intervals, followed by 4 courses of Docetaxel (70 mg/m(2))., Results: Treatment was performed in 14 patients including a male. Their age ranged from 37 to 69 years (mean, 55.3 years). Stage IIA was observed in 5 patients, IIB in 4, IIIA in 1, and IIIB in 4. In patients with Grade 3 or more, leukocytopenia was observed in 7 patients and diarrhea in 1 as adverse events. CR was obtained in 6 patients, PR in 5, and NC in 3 (response rate, 78.5%). Pathological examination showed pCR in 1 patient and pPR in 10 (response rate, 78.5%). Of the 10 patients with pPR, 2 showed a state near pCR., Discussion: Our results showed the safety and effectiveness of preoperative chemotherapy with CEF followed by Docetaxel.