Katsuhiko Inoue

Joint Symptoms : A Practical Problem of Anastrozole

BackgroundAnastrozole and tamoxifen have mild toxicity. However, we noticed that more patients treated with anastrozole complained of joint symptoms than expected. In particular, digital stiffness as is seen with rheumatoid arthritis is a problem. Some clinical trials of anastrozole in Europe and the United States reported musculoskeletal disorders as adverse events, however, joint symptoms were not described in detail.Patients and MethodsAt our clinic from August 2001 to March 2005, 53 postmenopausal women with estrogen receptor-positive breast cancer were treated with anastrozole. We calculated the incidence and classified the grade of joint symptoms by interviewing patients. We also investigated the patients’ characteristics and their relevance to joint symptoms.ResultsOf 53 patients, 14 patients (26%) had joint symptoms (13 patients with digital stiffness and 3 patients with arthralgias of wrist and shoulders). Joint symptoms tended to occur in the patients who had previously undergone chemotherapy; however, there has no relationship between prior hormonal therapy and joint symptoms. Seven patients who discontinued anastrozole treatment showed improved symptoms. Five patients with grade 1 digital stiffness continued anastrozole treatment without additional treatment. Two patients with grade 1 digital stiffness, who took a Chinese herbal medicine showed improved symptoms and continued anastrozole treatment.ConclusionBenefits to the patients may possibly be lost by discontinuation of anastrozole or changing to tamoxifen since the clinical superiority of anastrozole to tamoxifen has been reported. We should continue anastrozole in patients with low grade symptoms, while ensuring that patients are aware of the toxicity of anastrozole.

Repeated colon penetration by an ingested fish bone: Report of a case

A 78-year-old man was admitted to Kumamoto Rosai Hospital with right lower abdominal pain. Abdominal computed tomography (CT) showed penetration of the cecum by a foreign body, which looked like a fish bone, as well as thickening of the right lower abdominal wall. We made an initial diagnosis of penetration of the colon by an ingested fish bone and the patient was managed conservatively with fasting, peripheral parental nutrition, and intravenous antibiotics. By the next day, the right lower abdominal pain had diminished and a repeat CT scan showed that the fish bone had moved to the splenic flexure. However, 2 days later, the patient complained of pain in the left upper abdomen and another CT scan showed repeated penetration of the descending colon by the same fish bone. Thus, we removed the fish bone via endoscopic extirpation. The patient had an uneventful postoperative course and was discharged home 6 days later.

Onset of Liver Metastasis After Histologically Curative Resection of Pancreatic Cancer

PurposeWe assessed the possibility of predicting the time of onset of liver metastases by measuring the postoperative changes in serum carbohydrate antigen (CA)19-9 after curative resection of pancreatic cancers.MethodsAmong 28 patients who underwent histologically defined curative resection of pancreatic cancer between 1984 and 1999, liver metastasis developed in 11 patients with elevated serum CA19-9 levels. We plotted the serum CA19-9 levels against time on a semilogarithmic graph. Over the linear part of the curve, the time when log[CA19-9] equaled zero was defined as the time of onset of liver metastases. The log[CA19-9] level doubling time was then calculated and evaluated in relation to the survival period.ResultsThe serum CA19-9 levels increased linearly in 10 of the 11 patients. The predicted time of onset of liver metastasis ranged from preoperative day 163.0 to postoperative day 27.1, being preoperative in eight patients. The doubling time until death correlated strongly with survival in the eight patients with maintained log[CA19-9] linearity.ConclusionThe onset of liver metastases might be preoperative in patients with advanced pancreatic cancer. Therefore, neoadjuvant chemotherapy should be mandatory even if there is no sign of liver metastases.

Stromal sarcoma of the breast with lung metastases showing a clinical complete response to doxorubicin plus ifosfamide treatment: Report of a case

A 29-year-old woman presented with a painful right breast tumor, measuring 15 cm in diameter, which had progressed rapidly over 3 months. Core needle biopsy of the tumor revealed a malignant mesenchymal tumor. A mastectomy was performed, and pathological examination of the tumor showed stromal sarcoma. Solitary pleural dissemination in the right lung was suspected, based on the computed tomography image taken before the operation. Two months after surgery, bilateral multiple lung nodules were demonstrated. Systemic chemotherapy with doxorubicin plus ifosfamide was performed, and 3 months later the lung metastases had disappeared. Moreover, there is still no sign of recurrence at 5 months after the initiation of the chemotherapy. Breast stromal sarcoma is very rare, accounting for less than 1% of mammary neoplasms, and the treatment strategy is not well established, especially regarding chemotherapy. This case demonstrates the effectiveness of chemotherapy with doxorubicin plus ifosfamide for lung metastases from breast stromal sarcoma.

Experimental Studies on Protective Effects of FK506 Against Hepatic Ischemia-Reperfusion Injury

Purposes; FK506 (strong immunosuppressive agent) was investigated experimentally whether to protect the hepatic IRI. Methods; Warm ischemic experiment using pigs and rats were performed and examined whether FK506 is effective. Results; The results obtained are as follows. 1. Warm ischemia allowed time of the pigs without FK506 was 150 minutes, but as for that of FK506 group, the extension of 30 minutes was got in 180 minutes. 2. Biliary excretion rate of BSP after reperfusion were better in the group of 180 minutes ischemia with FK506 than in without FK506 group. 3. Chemiluminescence intensity in the peripheral neutrophils and adhered and infiltrated leukocytes in the liver were suppressed markedly by FK506. 4. The vascular endothelium with the scanning electron microscope was relatively preserved in the FK506 group comparing to the placebo group on 30 minutes after reperfusion. 5. Stress gastric ulcer was controlled and myeloperoxidase activity in the gastric mucosa was suppressed by FK506. Conclusion; Based on the results of theses experiments, it was suggested that FK506 has a protective effect on IRI by suppressing: the impairment of sinusoidal endothelial cells; the activation of KCs; the disturbance of micro-circulation; oxidative stress; inflammation; and the accumulation of leukocytes. J. Med. Invest. 63: 262-269, August, 2016.

A Case of the Tuberculous Peritonitis that Developed Torsion of the Small Intestine

小腸の軸捻転をきたした結核性腹膜炎の1例を経験したので報告する. 症例は76歳の女性で, 平成11年4月ころより臍周囲の鈍痛と微熱を自覚していた. 同年6月17日, 早朝より激しい腹痛が出現し, 急性腹症の診断にて当科へ紹介となった. 腹部CTにて小腸の腸間膜動脈を中心としたwhirl signを認め, 軸捻転が疑われた. 同日, 緊急手術を施行したところ, 腹腔内全体に蜘蛛の巣状の線維性癒着を認め, この癒着によって小腸が軸捻転を来たしていた. また, 腹膜, 腸間膜, 腸管の漿膜上には多数の粟粒大の黄白色結節を認めた. 癒着を剥離し, 捻転を解除したところ腸管の色調は回復した. 凍結切片にて, この結節から乾酪壊死を伴う類上皮肉芽腫を検出し, 結核性腹膜炎と診断した. 術後1週間目より肺結核に準じた抗結核剤を投与し, 以後腹部症状は認めていない.

A Case of Arteriovenous Malformation of the Pancreatic Body and Tail.

症例は53歳の男性. 突然の上腹部痛を主訴に某院に入院. 急性膵炎の診断にて治療を受けていたが症状軽快せず, 血管造影にて膵動静脈奇形と診断された. 一時症状軽快するが, 再び上腹部痛出現し, 加療目的で当科に入院となった. 腹部造影CTで膵体尾部がenhanceされ, MRI T1強調画像で同部に多数のsignal void signを認め, 速い血流の血管の存在が示唆された. カラードップラーエコーでは脾静脈に流入する動脈を認め, 血管造影では動脈相で膵体尾部に網目状異常動脈が描出され, 同時に門脈と脾静脈も描出された. 膵体尾部動静脈奇形と診断し, 膵体尾部, 脾合併切除を行った. 術中血行遮断に伴い門脈圧と門脈血中酸素分圧の低下を認め治療効果が確認できた.