A study was carried out to investigate the efficacy of therapy with recombinant human granulocyte colony-stimulating factor (rhG-CSF) in 24 patients with granulocytopenia and sepsis who had failed to respond to antibiotics. The mean leukocyte count at the start of the study was 911 +/- 334/microliter. Patients were injected subcutaneously with 75 micrograms rhG-CSF once daily for a mean of 5.2 days. The plasma G-CSF concentration was measured by ELISA. The leukocyte count increased approximately 9-fold after 1 week in 19 patients and the percentage of granulocytes rose from 46.2% to 78.9%. These 19 patients survived, while the 5 patients with no leukocyte response to rhG-CSF died. High plasma G-CSF levels were found in patients with granulocytopenia. Plasma G-CSF levels decreased as levels of granulocyte increased in survivors. A high plasma G-CSF concentration persisted in the 5 non-responding patients resulting in a fatal outcome. This study suggests that rhG-CSF both increased the leukocyte count and was a useful therapeutic manoeuvre for sepsis.

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Primary carcinoma of the small intestine is less common than carcinoma of other parts of the digestive tract. It is difficult to diagnose this condition even now, when diagnostic techniques for lesions of the digestive tract are highly advanced. Many cases are diagnosed after laparotomy on the basis of a diagnosis of ileus or acute abdomen.We have recently experienced a patient with primary carcinoma of the small intestine, and we report this case with reference to the literature. The patient, a 65-year-old woman, had a past history of surgery for acute appendicitis.She had a tendency toward constipation, occasionally leading to abdominal pain, which was relieved by evacuation. She had not undergone evacuation for two days before her visit to our hospital, and she presented with marked hypogastric pain and abdominal swelling. Although the symptoms were tentatively improved by consevative treatment on an inpatient basis, symptoms of ileus reappeared, leading to surgery. Surgery revealed circumscribed stenosis due to tumor in the ileum on the oral side 10cm from the ileocecal valve. Histopathological examination of the excised specimen revealed that the lesion was well-differentiated adenocarcinoma.

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