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Medication Misadventures Amid COVID-19 Patients in Saudi Arabic.
We encountered a case of acidosis exacerbated by hypercapnia that progressed to DIC during laparoscopic medial hepatectomy.A 71-year-old female was referred to our hospital for liver dysfunction. After careful examination, she was diagnosed with resectable pancreatic head cancer. Pancreatoduodenectomy was scheduled. In the laparotomy, 2 nodules on the liver were found. A frozen section examination of the liver nodule revealed adenocarcinoma. S-1 chemotherapy was administered for about 17 months to treat the unresectable pancreatic cancer. After chemotherapy, computed tomography(CT) revealed that the pancreatic tumor remained unchanged, and there was no distant metastasis. Positron emission tomography( PET)-CT revealed no significant uptake in the pancreatic tumor and no distant metastasis. The patient was then observed for about 10 months without chemotherapy. After that, CT showed that the size of the pancreatic tumor had increased, but there were no signs of distant metastases. Therefore, pancreatoduodenectomy was performed. Histopathological examination revealed invasive ductal adenocarcinoma in the pancreas head. The patient underwent adjuvant chemotherapy with S-1 for 5 months. So far, she has survived without any recurrence for 57 months after the initial surgery.A 96-year-old man was admitted to our hospital because of dysphagia. After examination, he was diagnosed with type 3 advanced gastric cancer in the antrum with duodenal invasion. A gastrojejunostomy was performed because of dissemination in the pelvic floor. He was put on pembrolizumab after surgery because the microsatellite instability test showed positive results. selleck The therapeutic response was PR. Pembrolizumab can improve the outcomes in elderly patients with unresectable advanced gastric cancer.A 51-year-old male underwent total gastrectomy for esophagogastric junction cancer(T3N0M0, Stage ⅡA). He was diagnosed with an alpha-fetoprotein(AFP) producing tumor and hepatoid adenocarcinoma. One month after radical surgery, computed tomography(CT) showed lung metastasis, and the patient's serum AFP level was high. He underwent chemotherapy( S-1 and wPTX/RAM)and eventually died 4 months after surgery.We present an unusual case of late-onset acute pneumonitis developing 21 months after pembrolizumab monotherapy. An 80-year-old male with primary, pulmonary, squamous cell carcinoma underwent right lower lobectomy and lymph node dissection(ND2a-2); the postoperative pathological stage was ⅢA(pT2bN2M0)and the PD-L1 tumor proportion score 70%. Six months after surgery, he developed mediastinal lymph node(#2R), bilateral pulmonary, and hepatic metastases; pembrolizumab was administered every 3 weeks as a first-line treatment. A partial response was evident after 3 courses; we thus continued the monotherapy. However, after 28 courses(21 months)of pembrolizumab, we discontinued the regimen because acute pneumonitis(Grade 3)developed; we prescribed prednisolone at 50 mg/day. The acute pneumonitis shadow improved and prednisolone was tapered over 2 months. The patient exhibited no new lesion and no progressive disease 6 months after pembrolizumab was discontinued.A 59-year-old female was referred to our hospital due to abnormal upper gastrointestinal(GI)findings in July 2019. Endoscopy showed an advanced type Ⅱ tumor at the esophagogastric junction. The bioptical diagnosis was adenocarcinoma. Computed tomography(CT)and positron emission tomography(PET)revealed a swollen lymph node and abnormal accumulation. Total gastrectomy and Roux-en-Y reconstruction were performed. The final diagnosis was esophagogastric junctional cancer and follicular lymphoma. The chance of encountering double cancer is likely to increase. It is vital to prioritize treatment and determine an appropriate treatment plan according to the clinical stage and prognosis in patients with double cancer.A 54-year-old man with a history of smoking developed infectious bullae at the apex of his left lung and underwent long-term antimicrobial treatment. The bullae gradually reduced in size along with a slight left pleural thickening. Left back pain relapsed after a year, and CT revealed a rapid increase in pleural thickening. Left upper lobectomy led to the diagnosis of pulmonary polymorphic carcinoma. Chronic inflammation due to infection could contribute to carcinogenesis; therefore, post-inflammatory changes should be carefully followed-up.The characteristic adverse events of olaparib, a PARP inhibitor, are nausea, vomiting, and anemia, and interstitial pneumonia is rarely reported. We report a case of interstitial pneumonia following the treatment of a metastatic breast cancer with olaparib. The patient was a 34-year-old woman. In March 2018, she was diagnosed with stage Ⅳ breast cancer(multiple lung metastases). She was treated with epirubicin and cyclophosphamide followed by paclitaxel. In November 2018, brain and spinal cord metastases were detected, and she was treated with radiation. In December 2018, a BRCA1 deleterious mutation was confirmed, and treatment with olaparib was initiated. Six weeks later, olaparib was discontinued due to anemia; it also caused interstitial pneumonia. The interstitial pneumonia resolved following multidisciplinary treatment during hospitalization. Subsequently, she was treated with cyclophosphamide/methotrexate/fluorouracil. It is necessary to consider interstitial pneumonia as an adverse effect of olaparib.The study subjects consisted of 54 patients with inoperable or recurrent breast cancer who were administered a combination of palbociclib plus endocrine therapy. We examined the onset of neutropenia during the first course of treatment and evaluated the influence that various risk factors had on treatment continuity. Patients with neutropenia Grade≥3 had significantly lower relative dose intensity(RDI) values during the first course of treatment than did patients with neutropenia Grade ≤2. Patients with neutropenia Grade≥3 showed significantly longer treatment to failure than did patients with neutropenia Grade≤2. These results suggest that the degree of neutropenia during the first course of treatment might contribute to treatment continuity and that it is important to improve the curative effect by maintaining appropriate RDI and by continuously administering palbociclib in patients with neutropenia Grade≥3.
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