1/243. Chemotherapy for advanced pancreatic cancer: it may no longer be ignored.Two case histories are reported here in which a chemotherapeutic approach improved the clinical conditions of patients with advanced pancreatic cancer. Until recently, chemotherapy was considered ineffective in pancreatic cancer, and most oncologists treated these patients with best-supportive-care only. Enthusiasm for systemic therapy of advanced pancreatic cancer is again growing, spurred by the advent of new drugs and new treatment endpoints such as life quality and symptom palliation. Gemcitabine, the most intensively-investigated new drug in pancreatic cancer, has shown an advantage in both survival and clinical benefit over that of 5-fluorouracil (5-FU). Other new drugs such as taxanes have shown interesting levels of activity, and are deserving of further evaluation. Although these results are far from conclusive and are only partially satisfactory, they represent a significant step forward in the treatment of advanced pancreatic cancer.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/243. hydroxyurea-induced fever in cervical carcinoma: case report and review of the literature.This is a case presentation of a rarely seen hydroxyurea-induced fever in a patient with cervical adenocarcinoma receiving oral hydroxyurea given concurrently with external beam radiotherapy to the pelvis. In the fourth week of treatment, the patient developed recurrent febrile episodes, with no obvious etiology. Eventually, hydroxyurea was discontinued with no further recurrence of fever. A review of the medical literature on fever induced by hydroxyurea suggests a mechanism of delayed hypersensitivity. Since hydroxyurea is an often-used chemotherapeutic drug for various malignancies, clinical oncologists need to be aware of this unusual side effect. The diagnosis is by clinical exclusion and by the recurrent pattern of fever on rechallenge of the drug.- - - - - - - - - - ranking = 0.66666666666667keywords = drug (Clic here for more details about this article) |
3/243. Urinary undiversion for pelvic actinomycosis: a long-term follow up.BACKGROUND: A 43-year-old woman who had been using intrauterine contraceptive devices for the past 10 years underwent an emergency operation for bowel and urinary obstruction. methods/RESULTS: Frozen section analysis showed undifferentiated adenocarcinoma. Incomplete tumorectomy, ileal resection, partial cystectomy, colostomy and bilateral ureterocutaneostomy were palliatively performed. Postoperatively, periodic acid-Schiff and Grocott-Gomori methenamine tests revealed actinomyces and the final diagnosis was pelvic actinomycosis. Treatment with penicillin g administered intravenously relieved her symptoms and the lesion was dramatically improved. The patient underwent colostomy closure and urinary undiversion. CONCLUSIONS: Five years after urinary undiversion, the patient's renal function has been maintained and she can void without incontinence and dysuria.- - - - - - - - - - ranking = 0.067124914525029keywords = closure (Clic here for more details about this article) |
4/243. Transmesenteric hernia after laparoscopic-assisted sigmoid colectomy.BACKGROUND AND OBJECTIVES: Laparoscopic-assisted surgery has been applied for a variety of colonic surgery. The objective of this paper is to demonstrate a possible and avoidable complication of laparoscopic colonic surgery. CASE PRESENTATION: A 47-year-old woman underwent gasless laparoscopic-assisted sigmoid colectomy. On the 20th postoperative day, she developed bowel obstruction. decompression with a long tube failed to resolve the bowel obstruction. Open laparotomy was performed. Abdominal exploration revealed a loop of the small bowel incarcerated in the mesenteric defect caused by the previous operation. Adhesiolysis was performed, and the postoperative course was uneventful. DISCUSSION: Despite technical difficulty, complete closure of the mesentery after bowel resection is strongly recommended for prevention of transmesenteric incarcerated hernia after laparoscopic surgery.- - - - - - - - - - ranking = 0.067124914525029keywords = closure (Clic here for more details about this article) |
5/243. A leptomeningeal metastasis revealed by sciatica.Meningeal metastatic disease usually occurs as a complication of a brain tumor and is exceptionally isolated in patients with solid tumors. We report the case of a 74-year-old woman admitted for mechanical S1 sciatica refractory to drug therapy. She had been treated for breast cancer three years earlier. Physical findings were pain upon hyperextension of the lumbar spine and absence of the ankle jerks. Analysis of cerebrospinal fluid sampled during an intrathecal glucocorticoid injection showed 1 g/L of protein and 11 normal cells per mm3. Grade 3 L5-S1 spondylolisthesis was seen on plain radiographs, computed tomography scans, and magnetic resonance imaging scans. At that point, the patient developed sphincter dysfunction and motor loss in the left lower limb in the distribution of several nerve roots. Findings were normal from a myelogram and a magnetic resonance imaging study of the brain. A repeat cerebrospinal fluid analysis showed 1.1 g/L of protein and 5 cells/mm3. Because of the discrepancy between the clinical and imaging study findings, the patient was transferred to a neurology department. A third cerebrospinal fluid study showed numerous adenocarcinoma cells, and a repeat magnetic resonance imaging demonstrated a mass in the dural sac opposite L2. A program of monthly intrathecal methotrexate injections was started. A fatal meningeal relapse occurred eight months later. CONCLUSION: This case shows that a leptomeningeal metastasis can cause isolated nerve root pain, and demonstrates the diagnostic value of magnetic resonance imaging and cerebrospinal fluid cytology in patients with atypical symptoms, particularly when there is a history of malignant disease.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
6/243. Fatal clostridium sordellii ischio-rectal abscess with septicaemia complicating ultrasound-guided transrectal prostate biopsy.clostridium sordellii is a Gram-positive spore-forming anaerobic bacillus rarely encountered in human infection. A case of C. sordellii ischio-rectal abscess with rapidly fatal septicaemia is described which complicated ultrasound-guided transrectal biopsy of the prostate, despite ciprofloxacin prophylaxis. Neither C. sordellii ischio-rectal abscess nor ischio-rectal abscess complicating transrectal biopsy have been reported previously. Judging from our experience and the reviewed literature, the addition of prophylactic anti-anaerobe drugs should be strongly considered until an optimal prophylactic regimen will be defined by randomized controlled trials.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
7/243. Fecal occult blood tests in occult gastrointestinal bleeding.Occult gastrointestinal bleeding is diagnosed by using one of the commercially available fecal occult blood tests (FOBTs). guaiac-based slide tests are most frequently used, although the more specific immunochemical methods are promising. The guaiac tests are inexpensive, nonspecific, qualitative measures of stool blood, and their use requires dietary and drug restrictions. Clinicians need to be aware of the causes of false-positive and false-negative test results. Although specific for the presence of human blood, immunochemical tests are more expensive and tend to react also to physiological quantities of blood in fecal specimens. Whichever test is chosen, it must be processed and read correctly. Annual FOBT screening for colorectal cancer, combined with periodic flexible sigmoidoscopy, is a cost-effective method of detecting early, curable colorectal cancer.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
8/243. methotrexate pneumonitis induced by intrathecal methotrexate therapy: a case report with pharmacokinetic data.A patient with adenocarcinoma of the breast metastatic to the leptomeninges was treated with 10 doses of intrathecal methotrexate (MTX) administered at intervals of 2 days. Following these treatments she developed fever, hypoxemia, and bilateral pulmonary infiltrates without documented pulmonary infection. autopsy findings were consistent with the pneumonitis that has been associated with intermittent oral, intramuscular, and intravenous MTX therapy. It is suggested that this patient's pulmonary process represented MTX pneumonitis following intrathecal MTX. cerebrospinal fluid and serum MTX concentrations determined retrospectively on frozen samples reflect an atypically rapid transport of MTX from this patient's cerebrospinal fluid to a slowly decaying systemic pool. Because of this, serum MTX levels probably exceeded 10-8M during the entire 20-day course of therapy, thus exposing the pulmonary parenchyma to significant drug concentrations for a prolonged interval. It is suggested that these unfavorable pharmacokinetics may have contributed to this patient's susceptibility to MTX pneumonitis.- - - - - - - - - - ranking = 0.33333333333333keywords = drug (Clic here for more details about this article) |
9/243. Desensitization to 5-fluorouracil.Anaphylactic reactions to 5-fluorouracil (5-FU) are uncommon. We report a 40-year-old female with adenocarcinoma of the ovary who had two reactions immediately after being infused with 5-FU. The second reaction occurred despite prophylaxis with steroids and antihistamines. The patient was positive to 5-FU on puncture skin testing even though there was no previous exposure to the drug. We successfully desensitized her to 5-FU using a continuous intravenous protocol with sequential increments in the fusion rates and drug concentrations. This desensitization method may be useful to manage systemic reactions to 5-FU and other drugs.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
10/243. Total anorectal and partial vaginal reconstruction with dynamic graciloplasty and colonic vaginoplasty after extended abdominoperineal resection: report of a case.PURPOSE: quality of life is altered after abdominoperineal resection, because of permanent iliac colostomy. Psychological rehabilitation is even more difficult after extended abdominoperineal resection to the vagina, because of the loss of both continence and sexual functions. We report the first case of total anorectal and vaginal reconstruction using dynamic graciloplasty and colonic vaginoplasty after extended abdominoperineal resection. methods: A 46-year-old female underwent extended abdominoperineal resection with posterior colpectomy for a low rectal adenocarcinoma infiltrating the anal sphincter and vagina. Anorectal reconstruction was performed with coloperineal anastomosis and double dynamic graciloplasty. Vaginal reconstruction was performed using a 10-cm, isolated, rotated sigmoid loop. The procedure was performed in three stages, including abdominoperineal resection with reconstruction, implantation of the stimulator, and closure of the temporary ileostomy. RESULTS: Resting and electrostimulated pressures of the neosphincter were 40 and 110 cm H2O respectively. Continence was achieved for formed stools two months after closure of the stoma, with spontaneous defecations (30-90 minutes). The patient experienced regular sexual activity six months after closure of the stoma. CONCLUSION: This new original technique can be proposed in selected young females after extended abdominoperineal resection, to preserve continence, sexual activity, and body image.- - - - - - - - - - ranking = 0.20137474357509keywords = closure (Clic here for more details about this article) |
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