Shigeki Takeshita

Severe 5-fluorouracil-induced toxicity due to decreased dihydropyrimidine dehydrogenase activity: report of a patient survival and urinary pyrimidine and dihydropyrimidine levels

Abstract We report a Japanese woman who survived severe 5-fluorouracil (5-FU) toxicity after receiving 5′-deoxy-5-fluoro-uridine (5′DFUR) for the treatment of breast cancer (pt2n1m1); the toxicity was due to decreased dihydropyrimidine dehydrogenase (DPD) activity. Pharmacokinetic investigation showed very high and prolonged plasma 5-FU concentrations after termination of the oral administration of 5′DFUR. The DPD activity in all plasma samples was below 30 pmol/min per mg protein. Her urinary thymine and uracil levels were high, and the ratios of urinary dihydrothymine/thymine and dihydrouracil/uracil were very low compared with the ratios in healthy people. These findings suggest that determination of urinary pyrimidine and dihydropyrimidine levels would be an appropriate urinary screening sytem that may be useful for evaluating DPD activity before 5-FU treatment is initiated.

Diagnostic usefulness of intraoperative ultrasonography in avoiding unnecessary para-aortic lymphadenectomy in women with endometrial carcinoma.

Objective: To evaluate the usefulness of intraoperative ultrasonography (IU) in reducing the number of unnecessary para-aortic lymphadenectomy in women with endometrial carcinoma. Methods: Computed tomography (CT) and IU were used to assess whether para-aortic lymph nodes were enlarged in 91 women with endometrial carcinoma. All women underwent hysterectomy and systematic pelvic and para-aortic lymphadenectomy. On the basis of the intrauterine pathological findings (IPF) of the removed uterus, the women were classified into low- and high-risk groups. It was assumed that para-aortic lymphadenectomy would be performed only when enlarged nodes were detected by CT or IU or only when women were classified into the high-risk group. The numbers of women who would have had missed metastases and who could have avoided para-aortic lymphadenectomy were calculated. Results: Eighteen women had pathological para-aortic node metastases. Theoretically, the number of women who would have had missed metastases on the basis of CT, IU, and IPF were 11, 2, and 2, respectively; more metastases were missed with CT than with the other 2 methods. The number of women who could have avoided para-aortic lymphadenectomy on the basis of CT, IU, and IPF were 84, 59, and 29, respectively; compared to IPF, IU helped avoid para-aortic lymphadenectomy in more women. Conclusions: Intraoperative ultrasonography is the most efficient method for avoiding both unnecessary para-aortic lymphadenectomy and missed para-aortic node metastases in women with endometrial carcinoma.

Case of minimal deviation adenocarcinoma: Possible clinical link to lobular endocervical glandular hyperplasia as its origin

Minimal deviation adenocarcinoma (MDA) is defined as an extremely well differentiated variant of endocervical adenocarcinoma. Several reports have stated that MDA associates with lobular endocervical glandular hyperplasia (LEGH). It is difficult to distinguish LEGH from MDA based on clinical and histologic similarities. There is no definite evidence proving that LEGH is a precursor lesion of MDA. A 45‐year‐old woman was admitted to our hospital for minute investigation of her neurological disorder. The multiple‐cystic lesion at the uterine cervix was identified by magnetic resonance imaging. Based on her normal histological findings and severe underlying conditions, a careful follow‐up strategy was adapted. Two years later, atypical glandular cells were observed and the multiple‐cystic lesion had increased. Pathological diagnosis of a conization specimen was MDA. Radical hysterectomy was carried out. Pathological examination revealed coexistence of LEGH and MDA. Her clinical course and histological findings suggested the possibility that LEGH might be a precursor lesion of MDA.

Postoperative concurrent chemoradiotherapy for the high-risk uterine cervical cancer.

Aim:  To determine whether concurrent chemoradiotherapy (CCRT) can improve the survival rate of high‐risk uterine cervical cancer.

Laparoscopic Laser Surgery on Gynecologic Disorder With KTP/532 Laser

Department of Obsterics and Gynecology Teikyo University School of Medicine We have performed some procedures of laparoscopic laser surgery with KTP/ 532 laser. All procedures were observed under video contrail with 3CCD camera. Using 5 to 15 watts of power from KIP/532 laser, a linear incision was made in the ovarian capsule and wall in ovarian chocolate cyst. After evacuation of bloody content, the cyst wall was completely removed. Filmy peritubular and periovarian adhesions were easily vaporized with KTP/532 laser. With more dense, vascular adhesions, the injury of adjacent tissue was minimized by KTP/532 laser system. The ablation of uterosacral ligament was performed on the posterior portion of ligament adjacent to uterine cervix. These all procedures tends to save patients time and discomfort. These complaints of all cases were immediately disappeared about 70 80% after laparoscopic surgery. The laparoscopic laser surgery is more effective and minimum invasive treatment for benign gynecologic disorders.