Yasushi Yoshida

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.

Can laparoscopic liver resection for colorectal liver metastases provide early initiation of adjuvant chemotherapy

The long-term outcome of patients with colorectal liver metastases (CRLM) has improved because of advances in surgical technique and perioperative chemotherapy (1-3). Liver resection followed by adjuvant chemotherapy (AC) provides better recurrence-free survival in patients with CRLM than surgery alone (4,5).

Comparison of laparoscopic versus open liver resection for hepatocellular carcinoma using propensity score matching

Laparoscopic liver resection (LLR) has become one of standard treatments for hepatocellular carcinoma (HCC). Numerous reports have demonstrated that LLR might be less invasive and provide better short-term results and identical oncological outcome compared to conventional open liver resection (OLR); however almost reports in the past were not conclusive. Propensity score matching (PSM) is a quite useful tool to match different background factors in the two groups; therefore, we reviewed papers assessing laparoscopic and OLR using PSM. We have already published the largest study of LLR for HCC from the “Project Committee of the Endoscopic Surgery” of the Japanese Society of Hepato-Biliary-Pancreatic Surgery. We summarized 10 documents including this paper. After PSM, maximum 387 patients undergoing laparoscopic and OLR were investigated. Less intraoperative blood loss or low rate of blood transfusion, and shorter hospital stay are solid advantageous results of LLR. Long-term outcome was quite equivalent in the two groups and special recurrence pattern in the LLR was rarely observed. These PSM studies clearly demonstrated that LLR can provide excellent perioperative benefits without oncologic disadvantages; therefore, we can strongly recommend LLR as a standard practice for properly selected patients with HCC.