[Immunomodulatory effect of daily low-dose cisplatin treatment]

Immunomodulatory effects of daily low-dose cisplatin treatment were investigated on compromised patients with advanced or recurrent gastrointestinal cancer. One case of esophageal cancer, 7 of gastric cancer, 2 of colorectal cancer, 1 of carcinomatous peritonitis from unknown origin, and 1 of hepatocellular carcinoma, were treated by daily low-dose cisplatin combined with 5-FU or tegafur, and their ECOG Performance Status Score (PS), number of lymphocytes, and CD3 zeta chain expression of peripheral blood lymphocytes were studied to compare with the effects of treatment. Seven patients with esophageal cancer and gastric cancer showed a partial response and their PS was improved, and the number of lymphocytes and CD3 zeta chain expression of lymphocytes was increased. However, in two patients with progressive disease, a decreased number of lymphocytes and less expression of CD3 zeta chain were seen.

Blunt pancreatic trauma with main pancreatic duct disruption managed successfully with total parenteral nutrition: report of a case

Although surgery is the usual treatment of choice for pancreatic trauma with disruption of the main pancreatic duct, we report herein the case of a patient in whom blunt pancreatic trauma with disruption of the proximal main pancreatic duct was successfully managed by conservative treatment. An 18-year-old women presented with abdominal pain 22 days after being involved in a car accident in which her upper abdomen was thrust against the steering wheel. Computed tomography revealed a pancreatic pseudocyst and a prevertebral pancreatic fracture, and endoscopic retrograde pancreatography showed complete disruption of the main pancreatic duct at the neck. Considering that the patient had been clinically stable since the accident, we elected to continue with conservative management and placed her on total parenteral nutrition. Rapid recovery followed and 6 years later, the patient remains well without any exocrine or endocrine insufficiency despite atrophy of the distal pancreas. This experience indicates that selected cases of main pancreatic duct disruption following blunt trauma may be amenable to conservative management.

[Nutritional assessments in the long-term survivors following massive resection of the small intestine]

Nutritional assessments were measured in the sixteen long-term survivors who had undergone a massive resection of more than two-thirds of the small intestine or less than 170 cm of the remaining small intestine. Prealbumin, retinol binding protein and zinc in serum and arm muscle circumference were significantly lower than the normal range. Serum albumin had a tendency to correlate to the length of the remaining small intestine. Nutritional risk index had a correlation with the length of the remaining small intestine. In this study, nutritional assessments in the patients with a massive resection of the small intestine indicated to be in preclinical malnutritional state. This may support that supplementary nutritional therapy is necessary for such patients. In addition, we reported a patient with sensory polyneuropathy caused by vitamin E deficiency due to short bowel syndrome. The level of vitamin E was low in his serum, 294 micrograms/dl (normal: 1004 +/- 65) and in his red blood cells, 136 micrograms/dl (normal: 176 +/- 9). His symptom was markedly decreased within two weeks after the administration of large doses of vitamin E.