levoleucovorin and Duodenal-Diseases

We report a very unusual case of malignant sigmoidoduodenal communication. To the best of our knowledge, this is the first documentation of this entity in the English language literature. A 76-year-old man presented with weakness, severe weight loss, foul-smelling eructations, anemia, constipation, and episodes of diarrhea. A sigmoidoduodenal fistula was found by barium enema, and a diagnosis of ulcerative colonic adenocarcinoma was made from the colonoscopy findings. Thus, we performed sigmoid colectomy with resection of the fistula and the involved anterior wall of the third duodenal part, followed by primary closure of the duodenal defect. Histological examination confirmed a Dukes' B (Stage II - T(4)N(0)M(0)) colonic adenocarcinoma, and the excision margins of the resected duodenal specimen were clear. We gave adjuvant chemotherapy with 5-fluorouracil and leucovorin. The patient is still alive and disease-free, 2 years postoperatively.

Topics: Adenocarcinoma; Aged; Chemotherapy, Adjuvant; Colonic Neoplasms; Duodenal Diseases; Fluorouracil; Humans; Intestinal Fistula; Leucovorin; Male; Sigmoid Diseases

We report a case of watery diarrhea due to duodenal toxoplasmosis in a patient with the acquired immunodeficiency syndrome. Treatment with pyrimethamine, clindamycin, and folinic acid decreased the diarrhea as well as the duodenal toxoplasma cyst load. Hepatic toxoplasmosis was also present, associated with an elevated serum alkaline phosphatase activity and a minimally elevated lactate dehydrogenase level.

Topics: Adult; AIDS-Related Opportunistic Infections; Anti-Infective Agents; Clindamycin; Diarrhea; Duodenal Diseases; Humans; Intestinal Diseases, Parasitic; Leucovorin; Liver Diseases, Parasitic; Male; Prevalence; Pyrimethamine; Toxoplasmosis

We present a case of metastatic sigmoid colon cancer causing duodenal perforation during modified FOLFOX6 chemotherapy. The patient was a 68-year-old man who underwent sigmoidectomy for an advanced sigmoid cancer in September 2007. He has been received mFOLFOX6 chemotherapy for multiple liver metastases since January 2009. In March 2010, the patient complained of abdominal pain during the 24th course of chemotherapy, and was admitted to our hospital. On admission, his vital signs were normal, and abdominal findings revealed no peritonitis signs. An abdominal CT scan showed free air and fluid collection on the first day of admission. The patient was diagnosed with gastrointestinal perforation, and underwent emergency operation for abdominal drainage. The leakage of biliary fluids was recognized at the drain to the Winslow postoperatively. It ceased on the 25th admission day, and an upper gastrointestinal examination showed good passage of fluids and no leakage at the duodenum. However, the patient died 36 days after admission from remarkable pleural effusion and respiratory failure.

Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Duodenal Diseases; Fluorouracil; Humans; Intestinal Perforation; Leucovorin; Male; Organoplatinum Compounds; Sigmoid Neoplasms

A system has been developed for the long-term continuous intravenous infusion of chemotherapeutic agents into unrestrained mice which allows new approaches to the toxicological and chemotherapeutic evaluation of antimetabolites. In mice, the concurrent infusion of thymidine and a source of preformed purine reversed both the toxicity and antitumor activity of MTX comparable to what was previously observed in cell culture. The infusion of thymidine alone, however, also blocked the toxicity of MTX without interfering with antitumor activity. A comparison of leucovorin rescue versus the utilization of thymidine plus preformed purine indicated that these salvage metabolites were as effective as leucovorin in reducing the toxicity of high-dose MTX while retaining antitumor activity.

Topics: Animals; Drug Therapy, Combination; Duodenal Diseases; Female; Infusions, Parenteral; Inosine; Lethal Dose 50; Leucovorin; Leukemia L1210; Methotrexate; Mice; Mice, Inbred DBA; Thymidine