[A Case of Advanced Gastric Cancer in Which Tumor Relapse Was Observed after Discontinuation of Nivolumab Due to Complete Response, and for Which Re-Administration Was Initiated]

A 61-year-old male was diagnosed with unresectable advanced gastric cancer(cT4b[SI; panc], N+, M0, cStage ⅣA). However he was administered S-1 plus oxaliplatin as a primary treatment and ramucirumab plus paclitaxel as a secondary treatment, the primary tumor and lymph nodes were enlarged. We judged PD and switched to the third-line treatment with nivolumab. After starting nivolumab, both the primary tumor and the lymph nodes shrank, and the PET-CT scan after 24 courses showed no FDG accumulation in the primary tumor or lymph nodes, so we judged the response as CR. The patient requested discontinuation of nivolumab, and nivolumab administration was stopped. Twenty months later after nivolumab administration was discontinued, CT scan showed re-growth of the primary tumor, and nivolumab administration was resumed. After resumption, he received 22 courses of nivolumab for 10 months with maintenance of SD.

Successful treatment of intractable chylous ascites after laparoscopic low anterior resection using lymphangiography and embolization with lipiodol: A case report

INTRODUCTION AND IMPORTANCE

Chylous ascites (CA) is an infrequent, intractable complication that may arise after abdominal surgery. Although various attempts at treatment have been adopted, to date, none of them have been consistently effective. We describe the successful treatment of CA using lymphangiography and embolization with lipiodol.

CASE PRESENTATION

A 79-year-old woman underwent laparoscopic surgery for rectum cancer at another hospital. She was discharged on postoperative day (POD) 9; however, she had to be treated and hospitalized for CA three times until POD 76. She visited our hospital to undergo treatment for CA on POD 90 because the previous conservative treatment had not improved her condition. The computed tomography (CT) scans revealed ascites effusion. We performed lymphangiography and embolization with lipiodol two times. Repeated CT on POD 134 showed that the ascites had not increased.

CLINICAL DISCUSSION

Lymphangiography and embolization with lipiodol effectively resolved chylous leakage that occurred after abdominal surgery. Additionally, we compare the features of two groups of cases of CA: one group in which patients were treated by lymphatic intervention and the second in which patients were treated through surgical procedures.

CONCLUSION

We were thus able to demonstrate the clinical effectiveness of lipiodol lymphangiography in treating CA.

Evaluation of leg edema using a multifrequency impedance meter in patients with lymphatic obstruction

To evaluate quantitatively local edema, electrical tissue impedance in the leg was measured with a multifrequency impedance meter in 10 patients without edema and in 10 other patients with lymphedema after hysterectomy for uterine cervical cancer (Groups 1 and 2, respectively). Equivalent resistivity of extra- and intracellular fluid (RE, RI, respectively) and the ratio RI/RE were calculated. The difference in mean RE between Groups 1 and 2 was significant (p less than 0.05). In four patients in Group 1 and nine in Group 2, simultaneous measurements were carried out on both legs. The differences between mean RE and RI/RE in Group 2 were significant (p less than 0.05, p less than 0.025, respectively). In these 13 patients, correlation coefficients between the ratio of cross-sectional areas of both legs, and both RE and RI/RE were -0.614 (p less than 0.05) and 0.805 (p less than 0.001), respectively. The results suggest that RE and RI/RE could be used as sensitive indicators of local edema.

Electrical measurement of fluid distribution in legs and arms

Intra- and extra-cellular fluid distribution is very important to know the physiological and clinical state of living subjects. However, it is quite difficult to measure the distribution in vivo. Electrical impedance of living tissue is mainly affected by extra-cellular fluid at an applied frequency lower than the beta-dispersion frequency, and is affected by both extra- and intra-cellular fluid at higher applied frequencies than that. In this paper, we discuss the problems of measurement of intra- and extra-cellular fluid distribution in living tissues by means of electrical impedance. The intra- and extra-cellular fluid distribution is related to some physiological parameters, such as blood circulation, metabolism of tissues, and the electrolytic concentration of intra- and extra-cellular fluids. Therefore, the information about the distribution of fluids in tissues is quite useful for the diagnosis of various diseases, the monitoring of seriously ill patients, and in medical treatments such as artificial dialysis. We discuss the method of measurement and the results of experiments.

Electrical measurement of fluid distribution in human legs: estimation of extra- and intra-cellular fluid volume

In this paper, we discuss the problems of measurement of intra- and extra-cellular fluid distribution in living tissues by means of electrical impedance. The intra- and extra-cellular fluid distribution is related to some physiological parameters, such as blood circulation, metabolism of tissues, and the electrolytic concentration of intra- and extra-cellular fluids. Therefore, the information about the distribution of fluids in tissues is quite useful for the diagnosis of various diseases, the monitoring of seriously ill patients, and in medical treatments such as artificial dialysis. We discuss the method of measurement and the results of experiments.