[Evaluation of postoperative pain relief by infiltration of bupivacaine or epidural block after laparoscopic cholecystectomy].

We compared the analgesic effect of bupivacaine infiltration into surgical wounds with that of epidural block after laparoscopic cholecystectomy (LC). Forty-five patients (ASA physical status I-II) for LC were randomized into three groups (n = 15 in each group). Patients received only general anesthesia (Group C), received infiltration of 0.5% bupivacaine into the surgical wound before surgery combined with general anesthesia (Group L), or received epidural anesthesia combined with general anesthesia (Group E). Postoperative pain was assessed using visual analogue scale (scale: 0-10) at 1, 2, 6 and 12 hours after the operation, the need for additional supplemental analgesics, and the cost of anesthesia. Visual analogue scale in Group C at 1, 2, or 6 hours was significantly greater than that of Group L and E. The number of patients who needed supplemental analgesics was 9 in Group C, 5 in Group L, and 2 in Group E. The cost of pharmaceutical and anesthetic practice of Group E was more expensive than Group L and C. In conclusion, infiltration of bupivacaine combined with general anesthesia is an effective and economical method of postoperative pain relief.

Administration of bisphosphonate prevents disuse bone atrophy induced by tail suspension.

We recently demonstrated that osteopenia induced by rat tail-suspension was associated with an initial increase in bone resorption. To study the significance of the increase in early bone resorption for osteopenia, we investigated whether administration of YH529, a third-generation bisphosphonate, prevents the development of osteopenia as evidenced by increased wet weight of the femur, together with its calcium and phosphorus contents, when compared with those of tail-suspended rats treated with the vehicle alone. These results suggested that the initial increase in bone resorption plays an important role in the development of osteopenia induced by tail suspension.

Effect of estrogen on the development of disuse atrophy of bone and muscle induced by tail-supension in rats.

Rat tail-suspension induces disuse atrophy of muscles and bones in hindlimbs. In the present investigation we studied how ovariectomy and estrogen substitution affect the development of the disuse atrophy induced by suspension. Five-week old female Wistar rats were ovariectomized and divided into two groups. One group received intramuscular injection of estradiol dipropionate once a week (OVX-E2 group), and the other received a vehicle injection (OVX group). After the third injection, each group was further divided into two groups, tail-suspended and non-suspended. After 7 days of tail-suspension, a significant decrease in the wet weight of femurs and their Ca and Pi content was observed in the OVX group. However, no significant change in those parameters was observed in the E2 group. In both E2 and OVX groups, a significant decrease in the wet weight of soleus and gastrocnemius muscles was demonstrated after the suspension. This demonstrated that estrogen administration to ovariectomized rats prevents the development of disuse bone atrophy but not that of muscle atrophy, suggesting that estrogen plays important roles in bone remodeling.

Postoperative adjuvant locoregional chemotherapy in patients with hepatocellular carcinoma.

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) recur frequently in HCC patients with invasive factors such as vascular invasion and intrahepatic metastasis and its prevention is important in obtaining better surgical survival. MATERIAL AND METHODS: Palliative resection with locoregional therapy for multinodular HCC was performed to prevent postoperative complications in patients with poor hepatic reserve. Disease-free survival (DFS) and survival for these patients who underwent hepatic resection for noninvasive HCC, and for invasive HCC with or without adjuvant chemotherapy were analyzed to determine the effects of adjuvant chemotherapy. Survival of palliative resection for HCC was analyzed to determine the effect of reduction surgery. RESULTS: DFS and survival of patients with adjuvant chemotherapy was better than those of patients without adjuvant chemotherapy, but not significantly (DFS; p = 0.0508, survival; p = 0.0570), and the survival of patients without adjuvant chemotherapy was almost equal to that of patients who underwent palliative resection. Adjuvant chemotherapy was effective in improving survival, but the effect was not satisfactory. CONCLUSIONS: Palliative resection was effective in treating multinodular HCC. Further trials are required to improve the surgical survival of patients with HCC.

Effects of bisphosphonate on bone metabolism in tail-suspended rats.

Our previous studies demonstrated that tail suspension causes early, transient increases in osteoclastic activity, followed by a decrease in osteoblastic activity in the hind limbs of rats. To assess whether this early increase in bone resorption is important in the development of disuse atrophy, the effect of YH529, a third generation bisphosphonate, was studied on hind limb atrophy in rats subjected to tail suspension. YH529 (YH group) or PBS (control group) were administered subcutaneously in 5-week-old male Wistar rats suspended for 7 days. In the control group, wet weight, calcium and phosphorus contents decreased significantly in the femur but they did not change in the humerus. In the YH group, however, these parameters did not change significantly in the femur, but both calcium and phosphorus increased significantly in the humerus. These results indicate that the inhibition of bone resorption by YH529 prevents the development of disuse atrophy induced by tail suspension. It is thus suggested that early increases in bone resorption are important for the development of disuse bone atrophy.

Postoperative adjuvant hepatic arterial infusion of Lipiodol containing anticancer drugs in patients with hepatocellular carcinoma.

Vascular invasion and intrahepatic metastasis by hepatocellular carcinoma are important factors predisposing to tumor recurrence. Recurrences of this malignancy occur frequently in residual liver, and its prevention is one of the most important factors in obtaining better surgical survival. Fifty patients who underwent hepatectomy for invasive hepatocellular carcinoma with vascular invasion and/or intrahepatic metastases were studied to evaluate the effect of adjuvant bolus hepatic arterial infusion of iodized poppyseed oil (Lipiodol) containing anticancer drugs in preventing recurrence and in prolonging survival. Patients were assigned to two treatment groups. Twenty-three of the fifty patients received adjuvant bolus infusion of Lipiodol containing doxorubicin and mitomycin C, whereas 27 patients received no therapy. The disease-free survival rate for the patients who received adjuvant therapy was significantly better (p < 0.05) than that for those who did not when measured at 172, 516, 688 and 860 days after hepatectomy, and the disease-free survival curve for patients with adjuvant therapy was significantly (p = 0.0237) better than that without adjuvant therapy. The cumulative survival rates and curves were not significantly different between the two groups. While adjuvant hepatic arterial infusion of Lipiodol containing anticancer drugs was effective in improving disease-free survival, the effect was not satisfactory. Further trials of adjuvant chemotherapy are required to improve the surgical survival of hepatocellular carcinoma patients.

Increased graft survival by utilization of 15-deoxyspergualin in a canine pancreatic allotransplantation model.

The purpose of this study was to evaluate the effectiveness of 15-deoxyspergualin (DSG) administration against acute rejection of canine pancreatic allografts. Subsequent to partial pancreatic allotransplantation and total extirpation of the pancreas, 20 adult mongrel dogs were divided into four groups and treated with saline (group 1, controls, n = 5), DSG at 1.0 mg/kg/day (group 2, n = 5), DSG at 3.0 mg/kg/day (group 3, n = 5), or DSG at 5.0 mg/kg/day (group 4, n = 5) on postoperative days 4-7. The graft survival, defined by a fasting serum glucose level < 150 mg/dl, was significantly prolonged from 6.2 +/- 1.2 days in group 1 to 12.4 +/- 2.7 days in group 3 (p < 0.05) and to 16.8 +/- 3.2 days in group 4 (p < 0.05). Graft survival was not significantly prolonged in group 2, however. Two normoglycemic dogs in group 4 died due to gastrointestinal toxicity, one of the most serious side effects of DSG. The observation that the serum insulin levels increased in dogs treated with DSG was compatible with dose-dependent graft survival and suggested that DSG had no toxic effects on pancreatic endocrine function. In group 1 significantly increased thromboxane B2 (TXB2) levels and TXB2/6-keto-prostaglandin F1 alpha (PGF1 alpha) ratios were observed on postoperative days 3-5 which was thought to reflect acute rejection. Following administration of DSG, both TXB2 levels and TXB2/PGF1 alpha ratios were decreased on the 5th postoperative day in groups 2-4.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prevention of postoperative recurrence of hepatocellular carcinoma by adjuvant locoregional chemotherapy].

Postoperative adjuvant locoregional chemotherapy was performed on patients who underwent hepatic resection for hepatocellular carcinoma with permeation of tumor into portal vein and/or into hepatic vein and/or intrahepatic metastasis to prevent recurrence. Twenty patients received intra-hepato-arterial infusion of chemotherapeutic drugs or Lipiodol, or transcatheter arterial embolization as adjuvant therapy, and 25 patients did not receive the therapy. There was no significant difference in the recurrence rate between the two groups, and disease-free-survival would not be improved significantly by adjuvant therapy. But the disease-free-survival was improved in patients who underwent relative noncurative hepatectomies. Median duration from the hepatic resection to the recurrence was prolonged by adjuvant therapy, but no significant difference was noted between the two groups. Serious hepatic injury was a side effect of adjuvant therapy in one patient. Therefore great care was necessary when performing the therapy. Further study on choice of the drugs and methods was considered necessary to obtain more effective therapy.

[Spread of surgical indication for hepatoma with postoperative transcatheter arterial infusion].

UNLABELLED: We evaluated the reduction surgery and the postoperative TAI for unresectable hepato-cellular carcinoma (HCC). Eight patients underwent reduction surgery and postoperative TAI (group I). Twenty-five patients underwent combination therapy with TAI, TAE, EI, hyperthermia and irradiation, who had not undergone reduction surgery (group II). Nine patients underwent a relative noncurative operation (group III). We studied the prognosis of these three groups. RESULTS: The one-year survival rates were 85.7% in group I, 38.6% in group II and 55.5% in group III. The three-year survival rates were 42.9% in group I, 10.7% in group II and 55.5% in group III. There was a significant difference of prognosis between group I and group II (p less than 0.05, generalized Wilcoxon). These results suggest that reduction surgery and post operative TAI for unresectable HCC improve the prognosis.

[Analysis of prognostic factors in patients with hepatocellular cancer treated by hepatic arterial infusion chemotherapy].

Analyses of the prognoses of thirty-four patients with hepatocellular cancer, who were treated by hepatic arterial infusion chemotherapy and/or transcatheter arterial embolization (TAE) and/or hyperthermotherapy, were performed by multivariate analysis using Cox's proportional hazard model and generalized Wilcoxon test. In the multivariate analysis on the conditions of patients, nine of fifteen variables were associated with the prognosis of patients who received regional cancer chemotherapy. The variables are: sex, liver cirrhosis, esophageal varices, GOT, GPT, albumin and gamma-globulin. One of three variables was associated with the prognosis in the therapy analysis, and the variable is TAE. Significant differences in survival curves which were estimated by generalized Wilcoxon test were noted in age, portal vein invasion, ascites, GOT and TAE. From these results it is suggested that the conditions of patients with unresectable hepatocellular cancer must be carefully investigated before regional cancer chemotherapy and the good therapy effects is obtained by hepatic arterial infusion chemotherapy combined with transcatheter arterial embolization therapy.

[Combined hepatic arterial infusion chemotherapy with transcatheter arterial embolization and hyperthermia in primary liver cancer].

Intrahepatic arterial infusion chemotherapy (HAI) was performed for 20 hepatocellular cancer (HCC) patients and 7 cholangiocellular cancer (CC) patients. HAI combined transcatheter arterial embolization (TAE) and/or hyperthermia were performed for 10 HCC and 3 CC patients. The effective responses were shown in 6 HCC and 1 CC patients who were treated with HAI-TAE-hyperthermia combination therapy, and 2 CC patients who were treated with HAI-hyperthermia combination therapy. The 1 and 2-year cumulative survival rate was 100% and 33.3%, respectively, for HCC patients treated with HAI-TAE-hyperthermia therapy. The 1 and 2-year survival rate for HCC patients treated with HAI therapy was 19.5%, and 7.3%, respectively. Generalized Wilcoxon test revealed that the survival was favorable for patients treated with HAI-TAE-hyperthermia therapy as compared with patients given with HAI therapy. Almost the same results were obtained in CC patients. These results suggest that the HAI-TAE-hyperthermia combination therapy was favorable for the treatment of advanced liver cancer.

Effect of traditional herbal medicine on serum testosterone levels and its induction of regular ovulation in hyperandrogenic and oligomenorrheic women (author's transl).

Eight infertile hyperandrogenic and oligomenorrheic women were investigated for lowering serum testosterone levels and inducing regular ovulation by Shakuyaku-Kanzo-To (mixed extracts of Paeonae Radix and Glycyrrhizae Radix). Serum testosterone levels (50-160 ng/dl) were lowered to less than 50 ng/dl in 7 patients by Shakuyaku-Kanzo-To 5-10 g daily administered for 2-8 weeks. Six of 7 patients ovulated regularly and 2 of 6 patients conceived. Serum LH levels, which were shown to be above 30 mIU/ml in 7 patients were lowered to less than 30 mIU/ml in 5 patients by dexamethasone 1 mg daily administered for 6.5 days. All of these patients ovulated regularly by Shakuyaku-Kanzo-To. No side effects were observed. Thus, Shakuyaku-Kanzo-To is indicated for lowering serum testosterone levels and inducing regular ovulation and pregnancy in infertile hyperandrogenic patients, especially in the patients whose serum LH levels were shown to be lowered to less than 30 mIU/ml by dexamethasone.

A case of granuloma of the ascending colon due to penetration of Trichuris trichiura.

A 33 year-old woman was admitted with chief complaint of abdominal pain and high fever. A barium-enema showed serration and a tumor was seen in the proximal ascending colon. At laparotomy, a localized tumor about 5 cm in diameter was located in the proximal portion of the ascending colon. The operation was made according to the ileoceal resection. On the macroscopic examination of the resected specimen, a small hole penetrating into the subserosa of the ascending colon was noticed and a tumor measuring approximately 3 x 1.2 x 1 cm was located under the hole. A female worm, Trichuris trichiura, was found to be harbored in the adjacent site of the lesion. Histopathologic examination revealed granulomatous tissue reaction due to penetrating of Trichuris trichiura. The patient is in good health now 20 months after operation.