CASE REPORT

Diagnosis: Pancreas cancer - MH

A 35-year-old man experienced pain and bloating in his abdomen following eating regular meals, and his urea color turned to yellow in May 2003. He presented to a private clinic, and spiral abdomen computer aided tomography (CAT) scan was performed on 21 May 2003 ( Appendix MH1 ). This revealed volumetric increase of the pancreas head, heterogeneity in the density of parenchyma, and multiple lymphadenopathies at the anterior site of the pancreas head. Magnetic resonance imaging (MRI) on 24 May 2003 demonstrated the same ( Appendix MH2 ). Ultrasound aided thin needle aspiration biopsy was performed on the same day. Ultrasound examination demonstrated a tumoral mass of 39x33 mm in the pancreatic head ( Appendix MH3 ). Histopathological examination of the biopsy specimen revealed the diagnosis as adenocarcinoma ( Appendix MH4 ). The patient was recommended chemotherapy, but he declined.

The patient presented to Dr. Ozel on 3 June 2003. On physical examination, he was pale, and there was swelling and pain at the epigastrium site. The painful region extended to the right epigastrium and right lumbar site. He had been using analgesics continuously to suppress the pain. 0.4 cc dose of N.O.I. caused the patient's body temperature to rise to 37.5^o C. The patient was then placed on a regimen of 0.4cc dose of NOI to be given daily six times a week; he was advised to adjust the dosage according to daily fever. He was also recommended to drink before meals 1cc of NOO three times daily.

Upper abdomen MR images obtained on 2 July 2003 demonstrated a contrast retaining lesion of 35x25 mm in the pancreatic head ( Appendix MH5 ). Numerous lymphadenopathies, of which the biggest one was 5 mm, were also revealed at the anterior site of the pancreas head and the stomach antrum posterior site.

The patient presented to Dr. Ozel on 17 September 2003 for a follow up visit. His general medical condition had improved considerably. He had none of the previous symptoms and was not using any analgesics anymore. He was advised to continue the same regimen.

MR images obtained on 1 October 2003 showed that the tumor in the pancreatic head measured 30x25 mm ( Appendix MH6 ). On this date, the patient's NOI regimen was changed to 0.8 cc daily, since even 0.8 cc was only causing a fever of 37.2^o C.

A bone scintigraphy was performed on 24 October 2003. It demonstrated no metastatic findings ( Appendix MH7 ).

After 15 November 2003, the patient experienced no fever following 0.8 cc dose of NOI injections, but he was advised to carry on the same regimen with daily 0.8 cc injections.

Upper and lower abdominal MR images obtained on 15 December 2003 demonstrated that the tumoral mass in the head of pancreas and all the lymphadenopathies had disappeared completely ( Appendix MH8 ).

On 26 December 2003 the patient was placed on a maintenance regimen with 0.8 cc of NOI to be given every two days, and 1cc of NOO three times daily.

The patient had an upper and lower abdominal MR on 10 February 2004. It showed no residual/relapse of the initial disease. The patient was advised to stop N.O. treatment ( Appendix MH9 ).

Another follow up upper and lower abdominal MR was performed on 19 June 2004. It also demonstrated no relapse of the pancreatic cancer tumor ( Appendix MH10 ).

As in March 2007, the patient has been in complete and sustained regression.