AIM:To evaluate the chemotherapeutic outcomes and confirm the recent improvement of prognosis for unresectable biliary tract cancer.METHODS:A total of 186 consecutive patients with unresectable biliary tract cancer,wh...AIM:To evaluate the chemotherapeutic outcomes and confirm the recent improvement of prognosis for unresectable biliary tract cancer.METHODS:A total of 186 consecutive patients with unresectable biliary tract cancer,who had been treated with chemotherapy between 2000 and 2009 at five institutions in Japan,were retrospectively analyzed.These patients were divided into three groups based on the year beginning chemotherapy:Group A(2000-2003),Group B(2004-2006),and Group C(2007-2009).The data were fixed at the end of December 2011.Overall survival and time-to-progression were analyzed and compared chronologically.RESULTS:No patient characteristics were significantly different among the three groups.The gallbladder was involved in about half of the patients in each group,and metastatic biliary tract cancer was present in three quarters of the enrollees.In Group A,5-fluorouracilbased chemotherapies were primarily selected as firstline chemotherapy,and only 24% were treated with second-line chemotherapy.In Group B,gemcitabine or S-1 monotherapy was mainly introduced as firstline chemotherapy,and 51% of the patients who were refractory to first-line chemotherapy were treated with second-line chemotherapy mainly with monotherapy.In Group C,the combination therapy with gemcitabine and S-1 was mainly chosen as first-line chemotherapy,and 53% of the patients refractory to first-line chemotherapy were treated with second-line chemotherapy mainly with combination therapy.The median timeto-progressions were 4.4 mo,3.5 mo and 5.9 mo in Groups A,B and C,respectively(4.4 mo vs 3.5 mo vs 5.9 mo,P < 0.01).The median overall survivals were 7.1,7.3,and 11.7 mo in Groups A,B and C(7.1 mo vs 7.3 mo vs 11.7 mo,P = 0.03).Induction rates of all three drugs(gemcitabine,platinum analogs,and fluoropyrimidine) in Groups A,B and C were 4%,2% and 27%(4% vs 2% vs 27%,P < 0.01).CONCLUSION:The prognosis of unresectable biliary tract cancer has improved recently.Using three effective drugs(gemcitabine,platinum analogs,and fluoropyrimidine) may improve the prognosis of this cancer.展开更多
AIM: To clarify the clinical significance of high serum IgE in autoimmune pancreatitis (AIP). METHODS: Forty-two AIP patients, whose IgE was measured before steroid treatment, were analyzed. To evaluate the relationsh...AIM: To clarify the clinical significance of high serum IgE in autoimmune pancreatitis (AIP). METHODS: Forty-two AIP patients, whose IgE was measured before steroid treatment, were analyzed. To evaluate the relationship between IgE levels and the disease activity of AIP, we examined (1) Frequency of high IgE (> 170 IU/mL) and concomitant allergic dis-eases requiring treatment; (2) Correlations between IgG, IgG4, and IgE; (3) Relationship between the presence of extrapancreatic lesions and IgE; (4) Re-lationship between clinical relapse and IgE in patients treated with steroids, and (5) Transition of IgE before and after steroid treatment. RESULTS: IgE was elevated in 36/42 (86%) patients.Concomitant allergic disease was observed in seven patients (allergic rhinitis in three, bronchial asthma in three, and urticaria in one). There were no signifi-cant correlations between IgG, IgG4, and IgE (r = -0.168 for IgG, and r = -0.188 for IgG4). There was no significant difference in IgE in the patients with and without extrapancreatic lesions (526 ± 531 IU/mL vs 819 ± 768 IU/mL, P = 0.163), with and without clini-cal relapse (457 ± 346 IU/mL vs 784 ± 786 IU/mL, P = 0.374). There was no significant difference in IgE between before and after steroid treatment (723 ± 744 IU/mL vs 673 ± 660 IU/mL, P = 0.633). CONCLUSION: Although IgE does not necessarily reflect the disease activity, IgE might be useful for the diagnosis of AIP in an inactive stage.展开更多
Gemcitabine chemotherapy has been the standard for advanced pancreatic cancer for more than a decade.New oral fluoropyrimidines such as S-1 and capecitabine are other key drugs.Gemcitabine plus erlotinib was the only ...Gemcitabine chemotherapy has been the standard for advanced pancreatic cancer for more than a decade.New oral fluoropyrimidines such as S-1 and capecitabine are other key drugs.Gemcitabine plus erlotinib was the only combination therapy that significantly prolonged survival,although the effect was minimal.Little or no improvement in survival with recent moleculartargeted drugs might be attributed to the very high incidence of K-ras gene mutation in pancreatic cancer.Recently,the non-gemcitabine-based-regimen of FOLFIRINOX showed significantly greater overall survival compared with gemcitabine for the first time.For biliary tract cancer,gemcitabine plus cisplatin combination chemotherapy has been proved to significantly prolong survival and will become the standard therapy.Further improvement in survival is expected by the addition of cetuximab.展开更多
Covered self-expandable metal stents were developed to overcome tumor in-growth through the metal mesh.Stent migration is one of their malfunctions.Recently,the partially covered wallflex stent(PCWS) was developed wit...Covered self-expandable metal stents were developed to overcome tumor in-growth through the metal mesh.Stent migration is one of their malfunctions.Recently,the partially covered wallflex stent(PCWS) was developed with flared ends to prevent migration However,difficulty has been reported in its removal.We describe the removal of a PCWS embedded in mucosal hyperplasia at the uncovered proximal flared end,visualized by using SpyGlass cholangioscopy.展开更多
Endoscopic self-expandable metal stent (SEMS) placement has become a standard palliative therapy for pa- tients with malignant biliary obstruction. Acute cholecystitis after SEMS placement is a serious complication. W...Endoscopic self-expandable metal stent (SEMS) placement has become a standard palliative therapy for pa- tients with malignant biliary obstruction. Acute cholecystitis after SEMS placement is a serious complication. We report a patient with an acute cholecystitis after covered SEMS placement, who was managed successfully with endoscopic transpapillary gallbladder drainage (ETGBD) and replacement of the covered SEMS. An 85-year-old man with pancreatic cancer suffered from acute cholecystitis after covered SEMS placement. It was impossible to perform percutaneous transhepatic gallbladder drainage. After removal of the covered SEMS with a snare, a 7Fr double pigtail stent was placed between the gallbladder and duodenum, subsequently followed by another covered SEMS insertion into the common bile duct beside the gallbladder stent. The cholecystitis improved immediately after ETGBD. ETGBD with replacement of the covered SEMS thus proved to be effective for treatment of patients with acute cholecystitis after covered SEMS placement.展开更多
文摘AIM:To evaluate the chemotherapeutic outcomes and confirm the recent improvement of prognosis for unresectable biliary tract cancer.METHODS:A total of 186 consecutive patients with unresectable biliary tract cancer,who had been treated with chemotherapy between 2000 and 2009 at five institutions in Japan,were retrospectively analyzed.These patients were divided into three groups based on the year beginning chemotherapy:Group A(2000-2003),Group B(2004-2006),and Group C(2007-2009).The data were fixed at the end of December 2011.Overall survival and time-to-progression were analyzed and compared chronologically.RESULTS:No patient characteristics were significantly different among the three groups.The gallbladder was involved in about half of the patients in each group,and metastatic biliary tract cancer was present in three quarters of the enrollees.In Group A,5-fluorouracilbased chemotherapies were primarily selected as firstline chemotherapy,and only 24% were treated with second-line chemotherapy.In Group B,gemcitabine or S-1 monotherapy was mainly introduced as firstline chemotherapy,and 51% of the patients who were refractory to first-line chemotherapy were treated with second-line chemotherapy mainly with monotherapy.In Group C,the combination therapy with gemcitabine and S-1 was mainly chosen as first-line chemotherapy,and 53% of the patients refractory to first-line chemotherapy were treated with second-line chemotherapy mainly with combination therapy.The median timeto-progressions were 4.4 mo,3.5 mo and 5.9 mo in Groups A,B and C,respectively(4.4 mo vs 3.5 mo vs 5.9 mo,P < 0.01).The median overall survivals were 7.1,7.3,and 11.7 mo in Groups A,B and C(7.1 mo vs 7.3 mo vs 11.7 mo,P = 0.03).Induction rates of all three drugs(gemcitabine,platinum analogs,and fluoropyrimidine) in Groups A,B and C were 4%,2% and 27%(4% vs 2% vs 27%,P < 0.01).CONCLUSION:The prognosis of unresectable biliary tract cancer has improved recently.Using three effective drugs(gemcitabine,platinum analogs,and fluoropyrimidine) may improve the prognosis of this cancer.
文摘AIM: To clarify the clinical significance of high serum IgE in autoimmune pancreatitis (AIP). METHODS: Forty-two AIP patients, whose IgE was measured before steroid treatment, were analyzed. To evaluate the relationship between IgE levels and the disease activity of AIP, we examined (1) Frequency of high IgE (> 170 IU/mL) and concomitant allergic dis-eases requiring treatment; (2) Correlations between IgG, IgG4, and IgE; (3) Relationship between the presence of extrapancreatic lesions and IgE; (4) Re-lationship between clinical relapse and IgE in patients treated with steroids, and (5) Transition of IgE before and after steroid treatment. RESULTS: IgE was elevated in 36/42 (86%) patients.Concomitant allergic disease was observed in seven patients (allergic rhinitis in three, bronchial asthma in three, and urticaria in one). There were no signifi-cant correlations between IgG, IgG4, and IgE (r = -0.168 for IgG, and r = -0.188 for IgG4). There was no significant difference in IgE in the patients with and without extrapancreatic lesions (526 ± 531 IU/mL vs 819 ± 768 IU/mL, P = 0.163), with and without clini-cal relapse (457 ± 346 IU/mL vs 784 ± 786 IU/mL, P = 0.374). There was no significant difference in IgE between before and after steroid treatment (723 ± 744 IU/mL vs 673 ± 660 IU/mL, P = 0.633). CONCLUSION: Although IgE does not necessarily reflect the disease activity, IgE might be useful for the diagnosis of AIP in an inactive stage.
文摘Gemcitabine chemotherapy has been the standard for advanced pancreatic cancer for more than a decade.New oral fluoropyrimidines such as S-1 and capecitabine are other key drugs.Gemcitabine plus erlotinib was the only combination therapy that significantly prolonged survival,although the effect was minimal.Little or no improvement in survival with recent moleculartargeted drugs might be attributed to the very high incidence of K-ras gene mutation in pancreatic cancer.Recently,the non-gemcitabine-based-regimen of FOLFIRINOX showed significantly greater overall survival compared with gemcitabine for the first time.For biliary tract cancer,gemcitabine plus cisplatin combination chemotherapy has been proved to significantly prolong survival and will become the standard therapy.Further improvement in survival is expected by the addition of cetuximab.
文摘Covered self-expandable metal stents were developed to overcome tumor in-growth through the metal mesh.Stent migration is one of their malfunctions.Recently,the partially covered wallflex stent(PCWS) was developed with flared ends to prevent migration However,difficulty has been reported in its removal.We describe the removal of a PCWS embedded in mucosal hyperplasia at the uncovered proximal flared end,visualized by using SpyGlass cholangioscopy.
文摘Endoscopic self-expandable metal stent (SEMS) placement has become a standard palliative therapy for pa- tients with malignant biliary obstruction. Acute cholecystitis after SEMS placement is a serious complication. We report a patient with an acute cholecystitis after covered SEMS placement, who was managed successfully with endoscopic transpapillary gallbladder drainage (ETGBD) and replacement of the covered SEMS. An 85-year-old man with pancreatic cancer suffered from acute cholecystitis after covered SEMS placement. It was impossible to perform percutaneous transhepatic gallbladder drainage. After removal of the covered SEMS with a snare, a 7Fr double pigtail stent was placed between the gallbladder and duodenum, subsequently followed by another covered SEMS insertion into the common bile duct beside the gallbladder stent. The cholecystitis improved immediately after ETGBD. ETGBD with replacement of the covered SEMS thus proved to be effective for treatment of patients with acute cholecystitis after covered SEMS placement.
