[Clinical trial of chemotherapy by superselective intra-arterial infusion of nedaplatin (CDGP) and 5-FU with concurrent radiotherapy for advanced oral cancer].

Nedaplatin (CDGP) is one of the platinum-derivatives to further improve the anti-tumor effect and to reduce adverse effects of cisplatin, such as renal toxicity. The present study evaluated the efficacy and adverse events of chemotherapy by superselective intra-arterial infusion of CDGP and 5-FU combined with concurrent radiotherapy in patients with advanced squamous cell carcinoma of the oral cavity. Sixteen patients were treated with CDGP plus 5-FU in combination with concurrent irradiation of 40.60 Gy. Ten patients were treated as a preoperative therapy and 6 as a definitive therapy. The overall clinical response rate was 93.8% and histological effects according to the grading system of Shimosato et al. were seen in 13/16 (81.2%). Adverse events were observed in all patients. Mucositis, leucopenia and thrombocytopenia (>Grade 2) were seen in 13 (81.3%), 11 (68.8%) and 8 (50.0%) of 16 patients, respectively. The overall 2-year and 4 months survival rate was 86.2%. One patient have died of disease and another of other causes. Concurrent chemoradiotherapy using CDGP plus 5-FU was tolerated with good clinical and histological effects,resulting in good local control for advanced oral carcinoma.

Reduction in incidence of methicillin-resistant Staphylococcus aureus (MRSA) after radical surgery for head and neck cancer.

This study investigated factors associated with the onset of methicillin-resistant Staphylococcus aureus (MRSA) infection among patients with head and neck cancer who underwent radical reconstructive surgery. The study group consisted of 103 patients who underwent radical reconstructive surgery between January 1994 to December 2002. They were divided into two groups with respect to the date of surgery: Group I (from January 1994 to December 1997) and Group II (from January 1998 to December 2002). The use of third-generation cephalosporins and imipenem as postoperative antibiotics was restricted after 1998 (Group II). A significantly lower incidence of MRSA was found in Group II than for Group I (p = 0.0069, chi2 test). The following factors were identified as being associated with the onset of MRSA infection: long surgical duration (p < 0.035, Wilcoxon signed-rank test), large hemorrhage (p < 0.049, Wilcoxon signed-rank test), and use of third-generation cephalosporins or imipenem (p < 0.004, chi2 test). MRSA infection was found more often in the surgically reconstructed tongue and floor of the mouth. The use of antibiotics such as vancomycin, wound irrigation, curettage and sequestrectomy were effective in eradicating the infection. MRSA, when it occurred in the maxilla, was mostly limited to colonization.

[The influence of intermittent hemodialysis (HD) on bispectral index (scale) (BIS) and serum propofol concentration under postoperative intravenous sedation].

We experienced a case of postoperative intravenous sedation with propofol during intermittent hemodialysis (HD), and investigated the correlation between the clinical sedation level based on bispectral index scale (BIS) together with Ramsay score, and the serum concentration of propofol. One adult oral cancer patient (carcinoma of the lower gingiva) with end-stage renal dysfunction needing HD was selected for this study. The day after operation, HD was commenced under intravenous sedation with propofol. Clinical sedation level was assessed using BIS and Ramsay score, and serum propofol concentrations were determined in arterial blood samples. Serum concentrations were measured every 15 times until 51 hours after operation. The initial dose of propofol was set at 3.5 mg x kg(-1) x h(-1) on the basis of clinical symptoms. According to BIS and Ramsay score, sedation level decreased lineally for 1 hour after commencement of HD. In contrast, serum propofol concentration incresed from 1.71 microg x ml(-1) to 2.21 microg x ml(-1). Total serum concentration of propofol was enhanced during HD because of dialytic dehydration, but, according to BIS and Ramsay scores, the possibility was suggested that the fraction of albmin-unbound propofol with pharmacological activities was eliminated or absorbed by membrane during HD.

[Effect of teeth protector on dental injuries during general anesthesia].

BACKGROUND: Dental injuries are the most common reason for complaints against anesthetists. The purpose of this study was to investigate the effect of teeth protector on dental injuries during general anesthesia. METHODS: Incidence of dental injuries was evaluated retrospectively in 5,946 consecutive patients between November 1998 and October 2001. All the patients were interviewed directly at a post-anesthetic clinic. RESULTS: Dental injuries were observed in 2.1% of the patients, and the injuries occurred more frequently in the patients undergoing difficult tracheal intubation. The teeth protector used in the present study was made of cellulose aceto-butylate and was produced using eruko-pressed disks molded from own teeth form. One hundred and eighty five patients (3.1%) requested teeth protectors, and none of them had their teeth injured during anesthesia. CONCLUSION: Our results showed that the teeth protector could protect the teeth from dental injuries and increased the satisfaction with anesthesia. Preoperatively anesthesiologists should know the characteristics of patients' teeth and inform the patients of the risk of injury. We conclude that the custom-made protector might be useful and necessary to preserve the teeth from dental injuries during anesthesia.