Ryoichi Kato

The patient was a 3-year-old boy with congenital absence of the portal vein. For hyperammonemia and large hepatic tumor of both lobes, he received an ABO-identical liver graft from his father via livingrelated liver transplantation. His preoperative fasting blood sugar level was within normal range, but increased within several hours after eating. His HbAlc level was 7.1% preoperatively, and HLA type was A24, A33, B61 and B44 in class I antigen and DR9, DR13 in class II antigen. Initially, tacrolimus was used as an immunosuppressive treatment with methylprednisolone. Although the liver function improved soon after surgery, the patient developed prominent hyperglycemia and appeared ketoacidosis three weeks later. Because the serum C-peptide hormone was a low value postoperatively, which expresses the status of disorder in self-insulin secretion, the patient required insulin administration to the control the blood sugar level. Insulin administration was started at 15-20 units per day and was reduced at the time of discharge, with conversion from tacrolimus to cyclosporin. Within our experience, tacrolimus may play an important role in developing insulin-dependent post-transplant diabetes mellitus as a side effect. Even for the case of a child, we evaluated sufficient postoperative glucose tolerance and it was thought that we should take measures. In addition, we need to examination the relationship in the future in order to understand whether or not HLA-A24, B61, DR9 are related to the onset of diabetes mellitus.

A 51-year-old female noticed a red-colored elevated tumor that had first appeared on her left femoral region at the age of 20. Thirty-one years later, the lesion was removed by plastic surgery at our hospital. After the excised tumor was diagnosed as a malignant melanoma, she consulted our department.<br>After an enlargement operation and lymphadenectomy, DAV-Feron and D-Feron chemotherapy were administered to her. Nine months later after the enlargement operation, we discovered metastatic tumors of the liver and skin. Arterial injection of cisplatin was given to combat the liver metastases, while local INF-gamma therapy was given for the metastatic tumors of the skin. Treatment with 70 mg/m²/M cisplatin by arterial injection remarkably reduced the volumes of the liver and skin tumors. The side effects, however, were severe, requiring a reduction of the cisplatin dose to 7 mg/m²/2W. As a consequence, the metastatic tumors of the skin proliferated. Then, treatment had to be interrupted, due to the secondary infection of an ileus. The patient later died from disseminated intravascular coagulation (DIC) and brain metastases.<br>In this instance, CDDP arterial injection therapy contributed to a temporary reduction of the metastatic tumor. Therefore, CDDP arterial injection therapy appears to be effective against liver metastases. [Skin Cancer (Japan) 2006; 21: 18-22]

高度進行肝癌症例に対してスフェレックス(DSM),イリノテカン(CPT-11),マイトマイシンC(MMC)を用いた経動脈化学塞栓療法(DSM-CPT療法)を施行した.大腸癌肝転移症例5例,胃癌肝転移症例2例,肝細胞癌症例2例,胆管細胞癌症例1例を対象とした.大腸癌肝転移症例では5例全例にPRが得られ,胃癌肝転移症例2例はいずれもPD,胆管細胞癌症例および肝細胞癌症例のうち1例にlong NCが,肝細胞癌症例の他の1例にPRが得られた.効果が最も高いと思われた大腸癌肝転移症例5例に関して検討を行った.全例で2ヵ月以上持続するPRが得られ,腫瘍マーカー値は,CEAおよびCA19-9が,それぞれ治療前値の16.1%,19.3%に減少した.dose設定を適切に行えば,DSM-CPT療法は外来での反復投与も可能であった