We report a case of multiple duodenal, pancreatic, and gastric carcinoids. A 67-year old woman was admitted to our hospital for treatment of a duodenal carcinoid. Laboratory tests revealed that the patient was associa...We report a case of multiple duodenal, pancreatic, and gastric carcinoids. A 67-year old woman was admitted to our hospital for treatment of a duodenal carcinoid. Laboratory tests revealed that the patient was associated with macrocytic anemia and hypergastrinemia, and type A gastritis was shown by gastrofiberscopy. During surgery, another tumor was incidentally found in the head of the pancreas. The tumors in the duodenum and pancreas were completely excised by pancreatoduodenectomy and immunohistologically diagnosed as gastrin-and serotonin-producing carcinoids, respectively. Pathological examination revealed that in addition to the grossly found carcinoids, there were subclinical carcinoids, one of which was an endocrine cell micronest, located in the stomach and duodenum. The tumors in the duodenum, pancreas, and stomach showed different characteristics from one another morphologically and immunochemically. Although no definitive evidence has been obtained, some sort of genetic anomaly may have been involved in this case, and hypergastrinemia due to duodenal gastrinoma may induce multiple gastric carcinoids.展开更多
Gastric carcinoma is one of the malignancies that are most frequently associated with esophageal carcinoma.We describe herein our device for advanced esophageal cancer associated with early gastric cancer in the antru...Gastric carcinoma is one of the malignancies that are most frequently associated with esophageal carcinoma.We describe herein our device for advanced esophageal cancer associated with early gastric cancer in the antrum.A 57-year-old man presenting with dysphagia and upper abdominal pain was admitted to our hospital.Preoperative examinations revealed locally advanced squamous cell carcinoma (SCC) of the middle thoracic esophagus (T3N0M0 Stage ⅡA) and mucosal signetring cell carcinoma of the gastric antrum (T1N0M0 Stage ⅠA).Although the gastric tumor appeared to be an intramucosal carcinoma,its margin was obscure,so endoscopic en-bloc resection was considered inadequate.We chose surgical resection of the gastric tumor as well as the esophageal SCC after neoadjuvant chemotherapy with 5-fluorouracil and cisplatin for advanced esophageal cancer.Following transthoracic esophagectomy with three-field lymph node dissection,the gastric carcinoma was removed by gastric antrectomy,which preserved the right gastroepiploic vessels,and a pedunculated short gastric tube was used as the esophageal substitute.Twenty-eight months after the surgery,the patient is well with no evidence of cancer recurrence.Because it minimizes surgical stress and organ sacrifice,gastric tube interposition is a potentially useful technique for esophageal cancer associated with localized early gastric cancer.展开更多
Purpose: The aims of this pilot study were to reveal the biological characteristics of serum I-FABP and explore its clinical utility as a biomarker in patients with small bowel obstruction (SBO). Methods: Serum I-FABP...Purpose: The aims of this pilot study were to reveal the biological characteristics of serum I-FABP and explore its clinical utility as a biomarker in patients with small bowel obstruction (SBO). Methods: Serum I-FABP levels were measured in 37 consecutive patients with SBO between 2007 and 2008. Serum I-FABP levels were compared between ischemia (n = 10) and non-ischemia (n = 27) groups. Serum I-FABP levels were longitudinally analyzed in 21 patients who showed high (>2.0 ng/ml) serum I-FABP levels. The relationship between serum I-FABP level and length of damaged bowel was also analyzed. Results: Median serum I-FABP levels were 9.2 ng/ml in the ischemia group and 1.9 ng/ml in the non-ischemia group (p < 0.0001). The elevated I-FABP levels rapidly decreased after therapeutic intervention and normalized on the third day in all patients. Linear regression analysis revealed a positive correlation between I-FABP levels and lengths of surgically excised bowels (y = 2.527x - 7.660, r = 0.604, p = 0.0018). By setting the cutoff level at 7.2 ng/ml, the diagnostic ability of serum I-FABP was 70.0% in terms of sensitivity, 92.6% in terms of specificity, and 86.5% in terms of accuracy. Conclusion: Serum I-FABP sensitively reflects bowel damage in SBO patients and seems to be a potential biomarker for detecting small-bowel ischemia.展开更多
文摘We report a case of multiple duodenal, pancreatic, and gastric carcinoids. A 67-year old woman was admitted to our hospital for treatment of a duodenal carcinoid. Laboratory tests revealed that the patient was associated with macrocytic anemia and hypergastrinemia, and type A gastritis was shown by gastrofiberscopy. During surgery, another tumor was incidentally found in the head of the pancreas. The tumors in the duodenum and pancreas were completely excised by pancreatoduodenectomy and immunohistologically diagnosed as gastrin-and serotonin-producing carcinoids, respectively. Pathological examination revealed that in addition to the grossly found carcinoids, there were subclinical carcinoids, one of which was an endocrine cell micronest, located in the stomach and duodenum. The tumors in the duodenum, pancreas, and stomach showed different characteristics from one another morphologically and immunochemically. Although no definitive evidence has been obtained, some sort of genetic anomaly may have been involved in this case, and hypergastrinemia due to duodenal gastrinoma may induce multiple gastric carcinoids.
文摘Gastric carcinoma is one of the malignancies that are most frequently associated with esophageal carcinoma.We describe herein our device for advanced esophageal cancer associated with early gastric cancer in the antrum.A 57-year-old man presenting with dysphagia and upper abdominal pain was admitted to our hospital.Preoperative examinations revealed locally advanced squamous cell carcinoma (SCC) of the middle thoracic esophagus (T3N0M0 Stage ⅡA) and mucosal signetring cell carcinoma of the gastric antrum (T1N0M0 Stage ⅠA).Although the gastric tumor appeared to be an intramucosal carcinoma,its margin was obscure,so endoscopic en-bloc resection was considered inadequate.We chose surgical resection of the gastric tumor as well as the esophageal SCC after neoadjuvant chemotherapy with 5-fluorouracil and cisplatin for advanced esophageal cancer.Following transthoracic esophagectomy with three-field lymph node dissection,the gastric carcinoma was removed by gastric antrectomy,which preserved the right gastroepiploic vessels,and a pedunculated short gastric tube was used as the esophageal substitute.Twenty-eight months after the surgery,the patient is well with no evidence of cancer recurrence.Because it minimizes surgical stress and organ sacrifice,gastric tube interposition is a potentially useful technique for esophageal cancer associated with localized early gastric cancer.
文摘Purpose: The aims of this pilot study were to reveal the biological characteristics of serum I-FABP and explore its clinical utility as a biomarker in patients with small bowel obstruction (SBO). Methods: Serum I-FABP levels were measured in 37 consecutive patients with SBO between 2007 and 2008. Serum I-FABP levels were compared between ischemia (n = 10) and non-ischemia (n = 27) groups. Serum I-FABP levels were longitudinally analyzed in 21 patients who showed high (>2.0 ng/ml) serum I-FABP levels. The relationship between serum I-FABP level and length of damaged bowel was also analyzed. Results: Median serum I-FABP levels were 9.2 ng/ml in the ischemia group and 1.9 ng/ml in the non-ischemia group (p < 0.0001). The elevated I-FABP levels rapidly decreased after therapeutic intervention and normalized on the third day in all patients. Linear regression analysis revealed a positive correlation between I-FABP levels and lengths of surgically excised bowels (y = 2.527x - 7.660, r = 0.604, p = 0.0018). By setting the cutoff level at 7.2 ng/ml, the diagnostic ability of serum I-FABP was 70.0% in terms of sensitivity, 92.6% in terms of specificity, and 86.5% in terms of accuracy. Conclusion: Serum I-FABP sensitively reflects bowel damage in SBO patients and seems to be a potential biomarker for detecting small-bowel ischemia.
