Eiji Kurokawa

A new regimen for S-1 therapy aiming at adverse reaction mitigation and prolonged medication by introducing a 1-week drug-free interval after each 2-week dosing session: efficacy and feasibility in clinical practice.

BackgroundThe response rate of advanced or recurrent gastric cancer to S-1 (TS-1®) is 46.5%, which is higher than the response rate of this type of cancer to any other anticancer agent. However, the incidence of adverse reactions to this drug has also been reported to be as high as 83.2%. According to a postmarketing survey, adverse reactions to this drug begin to appear 2–3 weeks after the start of drug administration. With these findings in mind, we recently devised a new dosing regimen for the drug, by which the drug is administered for 2-week periods separated by 1-week drug-free intervals (the 2-week regimen). The aim of this retrospective study was to evaluate the efficacy and feasibility of the 2-week regimen in comparison with a 4-week dosing regimen with a 2-week interval between sessions (the 4-week regimen) as the historical control.MethodsThe subjects were 27 patients with advanced or recurrent gastric cancer who received S-1 therapy at our center between September 1999 and November 2001. Of these patients, 14 who received the 4-week regimen before January 2001 served as historical controls, and the results in these patients were compared with those of the remaining 13 patients, who received the 2-week regimen after February 2001. Patient backgrounds, adverse reactions, compliance, and efficacy were investigated retrospectively.ResultsThe incidence of adverse reactions tended to be lower in the 2-week-regimen group (77%) than in the 4-week-regimen group (93%). The percentage of patients who received the drug for 6 months in complete compliance with the dosing schedule, as calculated by the Kaplan-Meier method, was 85% in the 2-week-regimen group and 40% in the 4-week-regimen group. The response rate to the drug was 23% in the 2-week-regimen group and 21% in the 4-week-regimen group.ConclusionThese results suggest that this 2-week regimen may mitigate adverse reactions and prolong the medication period.

A Case of Basal Cell Carcinoma of the Nipple and Areola with Intraductal Spread

We report an 82-year-old Japanese woman with basal cell carcinoma of the left nipple and areola extending into the lactiferous duct. The patient developed a small papular lesion of the left areola about 1 year before admission. The lesion, which had slowly progressed to involve the nipple, had become symptomatic showing weeping and bleeding. Mammography revealed microcalcification in the nipple. Although Paget’s disease was suspected from these clinical features, histologically basal cell carcinoma was diagnosed. There was no axillary lymphadenopathy, and no evidence of distant metastasis. The lesion of the nipple and areola was resected with a 2 cm free margin along with the underlying mammary tissue. The patient has remained well without signs of recurrence for 2 years after surgery. We reviewed cases of basal cell carcinoma of the nipple or areola and discuss considerations and problems of this rare tumor.

Data Processing for Radioimmunoassay Standard Curve Using Microcomputer: A New Basic Program for Weighted Logit-Log Transformation

A new BASIC program of the weighted linear, quadratic and cubic logit-log regression methods for data processing of radioimmunoassay standard curve was developed using a microcomputer. Using this program, three regression analyses are calculated and the table for root mean square of residuals in each regression are shown for the selection of the regression method. The data of three radioimmunoassays of human pancreatic enzymes and pancreatic secretory trypsin inhibitor were examined by this program and compared with those processed by the four parameter logistic method. The weighted cubic logit-log regression showed better fit in radioimmunoassays of human pancreatic enzymes with larger molecular weights. The present program is useful and practicable for its simplicity and accuracy.

Laparoscopic colectomy after self-expanding metallic stent placement through the ileocecal valve for right-sided malignant colonic obstruction: A case report

A 78‐year‐old man with a history of open sigmoidectomy for sigmoid cancer presented with abdominal pain and vomiting. Abdominal multi‐detector CT revealed an obstructive ileocecal tumor with distended small bowel on the oral side. We performed emergency drainage using a transnasal decompression tube, and 2 days later, we conducted a colonoscopic examination, which lead to a provisional diagnosis of obstruction with a malignant tumor invading the ileocecal valve. We then placed a self‐expanding metallic stent (SEMS) through the ileocecal valve. We confirmed patency of the ileocecal valve and removed the transnasal decompression tube 2 days after SEMS placement. We then performed elective laparoscopic colectomy 8 days after SEMS placement. To the best of our knowledge, there has been only one previous report of laparoscopic colectomy after decompression with SEMS placement through the ileocecal valve for right‐sided malignant colonic obstruction.

Broad ligament hernia successfully repaired by single‐incision laparoscopy: A case report

A 52‐year‐old woman with a history of two parturitions presented with lower abdominal pain. Multi‐detector CT of the abdomen showed discontinuity of the sigmoid colon near the broad ligament on the left side. We assigned a provisional diagnosis of an internal hernia progressing through a defect in the broad ligament. SILS revealed a total broad ligament defect on the left side but no signs of ischemic, necrotic bowel. We successfully repaired the broad ligament defect with suturing. At the 2‐month follow‐up, the patient remained well with no signs of recurrence. This case appears to be the first report of a broad ligament hernia successfully diagnosed and repaired by SILS.

Hepatobiliary and Pancreatic: Unusual case of radiation-induced biliary stricture

Case: A 71-year-old female was admitted for the treatment of jaundice to our hospital. Her computed tomography revealed stenosis of the central bile duct accompanied with an irregular nodule shadow. Her bile cytodiagnosis and bile duct biopsy results were negative. Patient had a history of radiation treatment for a MALT lymphoma. It seemed that this radiation therapy might be the cause of bile duct stricture. But, we did not deny the presence of a malignancy because the bile duct stricture had caused jaundice and radiologic presence of a nodule shadow. We performed extrahepatic bile duct resection and biliary reconstruction surgery, and her postoperative course was normal. Histopathological examination revealed fibrosis mainly in the submucosal layer in almost all areas of the common bile duct. Based on these findings, a final diagnosis of radiation-induced fibrotic change / bile duct stricture was made. Consideration: The report of biliary stricture after radiotherapy is very rare. A search of the PubMed database retrieved cases which included five cases of biliary tract malignancy ( two cases of hepatocellular carcinoma, one case of intrahepatic cholangiocarcinoma, and two cases of unknown origin ), and one case each of Hodgkin’s lymphoma, nonHodgkin’ s lymphoma, and gastric MALT lymphoma. For these cases, the irradiation dose was 20 85 Gy. The period from irradiation was 4.5 to 25 years. There was no trend in the original disease or radiation dose. It seemed that bile duct stricture tended to appear as a late symptom.Case: A 71-year-old female was admitted for the treatment of jaundice to our hospital. Her computed tomography revealed stenosis of the central bile duct accompanied with an irregular nodule shadow. Her bile cytodiagnosis and bile duct biopsy results were negative. Patient had a history of radiation treatment for a MALT lymphoma. It seemed that this radiation therapy might be the cause of bile duct stricture. But, we did not deny the presence of a malignancy because the bile duct stricture had caused jaundice and radiologic presence of a nodule shadow. We performed extrahepatic bile duct resection and biliary reconstruction surgery, and her postoperative course was normal. Histopathological examination revealed fibrosis mainly in the submucosal layer in almost all areas of the common bile duct. Based on these findings, a final diagnosis of radiation-induced fibrotic change / bile duct stricture was made. Consideration: The report of biliary stricture after radiotherapy is very rare. A search of the PubMed database retrieved cases which included five cases of biliary tract malignancy ( two cases of hepatocellular carcinoma, one case of intrahepatic cholangiocarcinoma, and two cases of unknown origin ), and one case each of Hodgkins lymphoma, non- Hodgkin’ s lymphoma, and gastric MALT lymphoma. For these cases, the irradiation dose was 20 - 85 Gy. The period from irradiation was 4.5 to 25 years. There was no trend in the original disease or radiation dose. It seemed that bile duct stricture tended to appear as a late symptom.