Naohide Isaka

Signet-ring cell carcinoma of the rectum treated with 105 administrations of sequential methotrexate and 5-fluorouracil as adjuvant therapy

Abstract A 51-year-old man underwent low anterior resection for signet-ring cell carcinoma of the rectum. Pathological examination revealed the existence of cancer cells in the anal surgical margin, even though findings in the intra-operative pathological examination of the frozen sample were negative. After surgery, biochemical modulation, of sequential methotrexate and 5-fluorouracil as adjuvant therapy, was started. Intermediate doses of methotrexate (100 mg/m2 = 170 mg/body) and 5-fluorouracil (600 mg/m2 = 1000 mg/body) were administered 105 times over a period of 3 years and 10 months after the operation. Dihydropyrimidine dehydrogenase activity in peripheral blood was examined twice and found to be high (484 and 378 pmol/min per mg protein). This high dihydropyrimidine dehydrogenase activity may explain the patients tolerance of 105 administrations of sequential methotrexate and 5-fluorouracil therapy. No recurrence had been detected by periodic colonoscopy, computed tomography, and ultrasonography until a recurrent tumor at the anastomotic site was recognized by colonoscopy 6 months after the last administration of the chemotherapy. After preoperative irradiation was carried out, abdominoperineal resection was performed. Two months after the second operation, he began a regimen of 5≧-doxifluridine (800 mg/day, orally), every day, and no further recurrence has been detected as of the time of this report (16 months after the second operation).

A Case of Small Bowel Obstruction due to Mycobacterium Avium Intracellulare Associated with the Acquired Immunodeficiency Syndrome.

AIDSが誘因となった播種性非定型感染症にて腸閉塞をきたした1例を経験した. 症例は48歳の男性. 主訴は腹痛と嘔吐であった. 開腹既往歴なし. 1996年カリニ肺炎にてAIDS発症, その後サイトメガロ網膜炎, 陰部ヘルペス, 頸部リンパ節腫脹を伴う播種性非定型抗酸菌感染症を発症し当院外来にて加療中であった. 2000年に左下腹部痛を主訴に当院を受診した. 身体所見上左下腹部圧痛を認め, 諸検査にて腸閉塞と診断され, 入院した. 入院3日後症状増悪し緊急開腹手術を施行した. 開腹所見にて, 横行結腸と癒着しarch を形成する上部空腸腸間膜リンパ節の著明な腫大を認め, 空腸が陥入し腸閉塞となっていた. Archを解除し陥入する小腸を引き出したところ, 腸管の色調は著明に改善を認めたために腸切除を行うことなく手術を終了した. 術後25日目に退院したが, 術後123日目にAIDSの増悪にて死亡した. AIDSが誘因となった腸閉塞は本邦でも今後増加する可能性があり, 文献的考察を加え報告する.