Hyperacute peripheral neuropathy is a predictor of oxaliplatin-induced persistent peripheral neuropathy.

PURPOSE: Chronic peripheral neuropathy is a major adverse response to oxaliplatin-containing chemotherapy regimens, but there are no established risk factors pertaining to it. We investigated the efficacy of hyperacute peripheral neuropathy (HAPN) as a predictor of oxaliplatin-induced persistent peripheral neuropathy (PPN). METHODS: Forty-seven cases of stage III colorectal cancer who received adjuvant chemotherapy with oxaliplatin after curative surgery between January 2010 and August 2014 were retrospectively reviewed. HAPN was defined as acute peripheral neuropathy (APN) occurring on day 1 (≤24 h after oxaliplatin infusion) of the first cycle. PPN was defined as neuropathy lasting >1 year after oxaliplatin discontinuation. RESULTS: The average total dose of oxaliplatin was 625.8 mg/m2, and the average relative dose intensity was 66.7%. Twenty-two of the 47 patients (46.8%) had PPN and 13 (27.7%) had HAPN. Male sex, treatment for neuropathy, HAPN, and APN were significantly more frequent in patients with PPN (p = 0.013, 0.02, <0.001, and 0.023, respectively). There was no significant difference in the total oxaliplatin dose between patients with and without PPN (p = 0.061). Multivariate analyses revealed total dose of oxaliplatin and HAPN as independent predictors of PPN [p = 0.015; odds ratio (OR) = 1.005, 95% confidence interval (CI), 1.001-1.009 and p = 0.001; OR = 75.307, 5.3-1070.123, respectively]. The total dose of oxaliplatin was relatively lower in patients with HAPN than that in those without HAPN in the PPN-positive group (not significant, p = 0.068). CONCLUSION: HAPN was found to be a predictor of oxaliplatin-induced PPN.

Management of obstructive colorectal cancer: evaluation of preoperative bowel decompression using ileus tube drainage.

PURPOSE: This study evaluated a better treatment for patients with obstructive colorectal cancer (CRC) that have a poor prognosis. METHOD: This study compared the outcomes of 138 patients with obstructive CRC, including 70 primary resections, 50 resections after bowel decompression using an ileus tube, and 18 delayed resections after colostomy. RESULTS: The ileus tube and delayed resection groups included more left-sided primary lesions. The physiologic POSSUM, types 3-4, tumor size, CEA, and hospital stay of the delayed resection group were different, in comparison to both the primary resection and ileus tube groups. The histopathological type and depth of invasion of the delayed resection group included less well types and more T4 than those of the ileus tube group. The operative blood loss of the delayed resection group was more than that of the ileus tube group. There were no differences in the overall and disease-free survival among the three groups. CONCLUSION: Separately analyzing the data of the right-sided cancer group and the left-sided cancer group demonstrated that primary resection might be acceptable for right-sided obstructive CRC and delayed resection might be done for patients with poorer general conditions (high PPS) and poorer oncological prognostic factors such as more type 3/type 4 cases, a larger tumor size, a less well-differentiated histopathological type, more T4 cases, and a higher CEA level.

Evaluation of postoperative nutritional state after hepatectomy for hepatocellular carcinoma.

BACKGROUND/AIMS: In spite of many technical advances in liver surgery, optimal nutritional support after hepatectomy has not been established. METHODOLOGY: We clarified the actual nutritional state in 16 patients with total parenteral nutrition (TPN group), and 16 patients without total parenteral nutrition (PPN group), after hepatectomy for hepatocellular carcinoma without biliary tract reconstruction, in terms of preoperative clinical data, intraoperative indexes, postoperative management and complications, liver function data, nutritional state, and changes in metabolic parameters. RESULTS: There were no significant differences in any occurrences of postoperative complications, liver function data, or nutritional parameters between the two groups. On the other hand, the TPN group needed more doses of insulin than the PPN group. The beginning of each water and food intake was earlier in the PPN group than in the TPN group. The blood glucose level was higher in the TPN group than in the PPN group. The serum sodium and chloride levels were lower, but the serum potassium level was higher, in the TPN group compared to the PPN group. Thus, problems such as hyperglycemia and serum electrolyte abnormalities were more conspicuous in the TPN group than in the PPN group. CONCLUSIONS: In the actual clinical care after hepatectomy for hepatocellular carcinoma without biliary tract reconstruction, in which oral feeding is started early, total parenteral nutrition is considered unnecessary.

[Bacteria isolated from surgical infections and its susceptibilities to antimicrobial agents--special references to bacteria isolated between April 2001 and March 2002].

Isolated bacteria from infections in general surgery during the period from April 2001 to March 2002 were investigated in a multicenter study in Japan, and the following results were obtained. In this series, four hundred and twenty strains were isolated from 175 (79.2%) of 221 patients with surgical infections. One hundred and eighty-six strains were isolated from primary infections, and 234 strains were isolated from postoperative infections. From primary infections, anaerobic Gram-positive bacteria were predominant, while from postoperative infections, aerobic Gram-positive bacteria were predominant. Among aerobic Gram-positive bacteria, although the isolation rate of Staphylococcus aureus was the highest, followed by that of Enterococcus faecalis from primary infections, the isolation rate of E. faecalis was the highest from postoperative infections. Among anaerobic Gram-positive bacteria, the isolation rate of Peptostreptococcus spp. was the highest from both types of infections. Among aerobic Gram-negative bacteria, Escherichia coli was the most predominantly isolated from primary infections, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa in this order, and from postoperative infections, P. aeruginosa was the most predominantly isolated, followed by Enterobacter spp., E. coli and Klebsiella spp. Among anaerobic Gram-negative bacteria, the isolation rate of Bacteroides fragilis group was the highest from both types of infections. The isolation rate of aerobic Gram-negative bacteria from primary infections and that of aerobic Gram-positive bacteria from postoperative infections were high in the last several years. We noticed no vancomycin-resistant Gram-positive cocci.

Biliary drainage tube evaluation after common bile duct exploration for choledocholithiasis.

BACKGROUND/AIMS: We studied the postoperative evaluation of transcystic duct tube drainage (C-tube), T-tube drainage (T-tube), and retrograde transhepatic biliary drainage after common bile duct exploration for patients with choledocholithiasis. METHODOLOGY: We analyzed the preoperative clinical features of patients, intraoperative findings, postoperative status and management, daily output of bile, liver function, postoperative infections, and postoperative complications for patients who underwent common bile duct exploration including 16 C-tube, 17 T-tube, and 8 retrograde transhepatic biliary drainage cases. RESULTS: There were no significant differences in the preoperative clinical features, intraoperative findings, or the daily output of bile from the tube. The removal day of the biliary drainage tube and postoperative hospital stay were shorter in the C-tube group than in the T-tube and retrograde transhepatic biliary drainage groups. Aspartate amino-transferase level and body temperature in the C-tube group on day 7 were lower than those in the T-tube group, and the total bilirubin level in the C-tube group on day 14 was lower than in the T-tube and retrograde transhepatic biliary drainage groups. Moreover, postoperative complications occurred significantly less frequently in the C-tube group (25.0%) than in the T-tube group (76.5%). CONCLUSIONS: C-tube drainage is thought to be most useful after common bile duct exploration for patients with choledocholithiasis.

Postoperative evaluation of C-tube drainage after hepatectomy.

BACKGROUND/AIMS: In spite of recent advances in liver surgery, biliary complications remain a common cause of major morbidity after hepatectomy. METHODOLOGY: We studied the postoperative evaluation of 28 hepatectomied patients with transcystic duct tube (C-tube) drainage (C-group), compared with 38 hepatectomied patients without C-tubes (NC-group), in terms of preoperative clinical profiles of patients, intraoperative findings and procedures, postoperative management and bile leakage, daily output of bile, liver function and postoperative infections. RESULTS: There were no significant differences in the preoperative clinical profiles of patients and postoperative management between the two groups. In intraoperative findings and procedures, the tumor size, weight of the resected liver, operation time and operative blood loss were higher in the C-group than those in the NC-group. Therefore, the operative procedure was more serious in the C-group than that in the NC-group. However, bile leakage was observed in only one of 28 patients (3.6%) in the C-group and 10 of 38 patients (26.3%) in the NC-group, that is, bile leakage occurred less frequently in the C-group than in the NC-group. The daily output of bile in the C-group was thought to be enough to decompress the biliary tree. In liver function, aspartate aminotransferase and alanine aminotransferase had lower levels in the C-group than those in the NC-group with bile leakage. White blood cell count, C-reactive protein and body temperature were closer to the normal range in the C-group than those in the NC-group with bile leakage. CONCLUSIONS: C-tube drainage after hepatectomy is thought to be useful for decreasing postoperative complications, especially bile leakage.

[Bacteria isolated from surgical infections and their susceptibilities to antimicrobial agents. Special references to bacteria isolated between April 1999 and March 2000].

The annual multicenter studies on isolated bacteria from infections in general surgery and their antimicrobial susceptibility have been conducted in Japan since July 1982. In this paper, the results obtained in the academic year 1999 (from April 1999 to March 2000) have been summarized. Two hundred seven cases were investigated, and 411 strains were isolated from 169 cases (81.6%). Of those strains, 184 and 227 strains were from primary infections and postoperative infections, respectively. In primary infections, the isolation rates of anaerobes, Streptococcus spp., and Escherichia coli were higher than in postoperative infections, while in postoperative infections, those of Gram-positive aerobes were higher than in primary infections. Staphylococcus aureus were most frequently isolated among Gram-positive aerobes, Peptostreptococcus prevotii among Gram-positive anaerobes, E. coli among Gram-negative aerobes, and Bacteroides fragilis among Gram-negative anaerobes. In primary infections, the percentage of Gram-negative aerobes, which gradually increased by the year 1998, decreased in the year 1999. The percentage of Gram-negative anaerobes increased, while that of Gram-negative bacteria was equivalent to that in the last year. In postoperative infections, the percentage of Gram-negative anaerobes, which continuously increased after the year 1990, decreased, while that of Gram-positive aerobes, which decreased in the last year, increased. Methicillin-resistant S. aureus accounted for 70.7% of S. aureus (41 strains). Either the number of strain or the percentage of MRSA decreased. The susceptibilities of E. coli and Klebsiella pneumoniae decreased against third and forth generation cephems, oxacephems, and monobactams. The susceptibilities of P. aeruginosa to carbapenems tend to decrease after the year 1997. S. aureus showed good susceptibilities to the tested drugs including arbekacin, vancomycin, and teicoplanin.

[Bacteria isolated from surgical infections and their susceptibilities to antimicrobial agents--special references to bacteria isolated between April 2000 and March 2001].

Tendency of isolated bacteria from infections in general surgery and their antimicrobial susceptibilities during the period from April 2000 to March 2001 were investigated in a multicenter study in Japan, and the following results were obtained. The number of cases investigated as objectives was 234 for one year. A total of 388 strains (136 strains from primary infections and 252 strains from postoperative infections) were isolated from 165 cases (70.5% of total cases). In primary infections, anaerobic Gram-positive bacteria were predominant, while from postoperative infections, aerobic Gram-positive bacteria were predominant. Among aerobic Gram-positive bacteria, the isolation rate of Enterococcus faecalis was the highest, followed by that of Staphylococcus aureus from postoperative infections. Among anaerobic Gram-positive bacteria, the isolation rate of Peptostreptococcus spp. was the highest from both types of infections. Among aerobic Gram-negative bacteria, Escherichia coli was the most predominantly isolated from primary infections, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa in this order, and from postoperative infections, P. aeruginosa was the most predominantly isolated, followed by Enterobacter spp. and Klebsiella spp. Among anaerobic Gram-negative bacteria, the isolation rate of Bacteroides fragilis group was the highest from both types of infections. There was no vancomycin-resistant S. aureus nor Enterococcus spp. Among anaerobic bacteria, there were many resistant strains against penicillins and cephems with MICs higher than 100 micrograms/ml, and the same trend was observed among other Bacteroides spp. and Prevotella spp.