Kazuma Fukuda

Paraneoplastic hypercalcemia with adenosquamous carcinoma of the colon.

Hypercalcemia is a well-known manifestation of paraneoplastic syndromes associated with a variety of malignancies. However, colon cancer has only rarely been associated with hypercalcemia. Here we present the first case of adenosquamous carcinoma of the sigmoid colon in a patient who was found to have hypercalcemia associated with parathyroid hormone-related protein (PTHrP), with no radiological evidence of metastasis to other organs. A 78-year-old woman was admitted to our hospital complaining of lower abdominal pain. Physical examination and computed tomography revealed a tumor, 13 cm in diameter, in the sigmoid colon. Laboratory data showed an elevated serum calcium level (11.2 mg/dl). Primary colostomy was performed. After the primary operation, the patient was found to have hypercalcemia and an elevated PTHrP level. We performed sigmoidectomy, total hysterectomy, and partial urinary bladder resection 1 month after the primary operation, and both PTHrP and calcium levels immediately returned to normal. The histopathologic diagnosis was poorly differentiated adenosquamous carcinoma. The patient died due to tumor recurrence 4 months after the second surgery.

Pancreatitis Induced by Valproic Acid: Report of a Case

Abstract A 22-year-old woman with intellectual impairment, who had been taking valproic acid continuously for 19 years since being diagnosed with epiloia at the age of 3 years, presented to our hospital following the sudden development of epigastric pain. An abdominal computed tomography scan revealed acute exacerbation of chronic pancreatitis. Conservative treatment was initiated, despite which the pancreatitis became exacerbated, necessitating resection of the pancreatic head and duodenum. Histological examination of the resected specimens revealed a large number of pancreatic calculi in the main pancreatic duct, suggesting chronic pancreatitis with fibrosis at the periphery. The incidence of pancreatitis developing in association with valproic acid is unclear; however, only 40 such cases have been reported in the English literature. Most of the patients previously described presented with acute pancreatitis in the initial stage. However, the clinical course of our patient, with acute exacerbation following a relatively chronic course, was different from those previously described, suggesting the presence of chronic pancreatitis related to valproic acid.

CLINICAL FEATURES AND SURGICAL MANAGEMENT OF THE POSTOPERATIVE MASSIVE GASTRDUODENAL HEMORRHAGE

上部消化管手術を除く術後胃十二指腸大量出血の15手術症例を経験したが, 原疾患は血管と消化器疾患が大半を占め, 発生頻度は0.5%である.出血は73%が原疾患手術後2週間以内に起こり, 概ね重篤なほどより早期に出血している, 症例は出血性胃炎2, 胃潰瘍6, 十二指腸潰瘍7からなり, 多発性病巣が多い.広範囲胃切除術による治療成績は生存率67%, 死亡率33%, 再出血1例であり, 術前合併症を有するものの成績が不良である.胃潰瘍症例は全例救命しているが, 他の病変の成績がわるい.待期々間別の成績は3日以内が75%で最も良好である.治療にさいしては合併症の存否を斜酌して, 早期に手術適応の可否を決断すべきである.