[Usefulness of continuous arterial infusion chemotherapy for post operative multiple recurrence and residual hepatocellular carcinoma].

Twenty five patients with postoperative multiple recurrence and residual hepatocellular carcinoma received continuous arterial infusion of CDDP and 5-FU via implanted reservoir. For the next five days, 10 mg/body of CDDP and 250 mg/body of 5-FU using arterial infusion were administered. It was discontinued for two days as one course, and 4 courses were basally administered. The efficacy rate was 60%, and there were 7 (28%) CR (complete response) cases. The survival rate was 76.0% for 1 year and 36.5% for 3 years, which is a favorable result considering their advanced stage. Thus, this treatment seemed to be effective for multiple hepatocellular carcinoma.

[The study of continuous arterial infusion chemotherapy with CDDP and 5-FU in patients with hepatocellular carcinoma].

Between Feb. 1992 and April in 1995, 22 patients with hepatocellular carcinoma (10, recurrence; 12, unresectable) received continuous arterial infusion of CDDP and 5-FU via implanted reservoir. For the next five days, 10 mg/body of CDDP and 250 mg/body of 5-FU using arterial infusion were administered. It was discontinued for two days as one course, and 4 courses were basally administered. Patients were divided into 2 groups (6 hours group and 24 hours group) according to the duration of the administration of 5-FU. There were no differences in efficacy rate between the 2 groups (6 hours group, 64%; 24 hours group, 62.5%), but CR (complete response) cases appeared in only the 6 hours group. There were no severe side effects in the 2 groups, but systemic side effects appeared in 6 hours group more often than in 24 hours group. Only in the 24 hours group, 2 patients had the narrowing and obstruction of hepatic artery which was suggested to be caused by intimal injury due to continuous administration of 5-FU. Continuous arterial infusion chemotherapy with CDDP and 5-FU seemed to be effective. Further study on adequate time and volume of administration including pharmacokinetics is needed to enhance the clinical effectiveness of continuous arterial infusion of CDDP and 5-FU.

[The study of continuous arterial infusion chemotherapy with 5-FU and CDDP in patients with hepatocellular carcinoma].

Between Feb. 1992 and March in 1994, 14 patients with hepatocellular carcinoma (7: recurrence, 7: unresectable) received continuous arterial infusion of 5-FU and CDDP via implanted reservoir. For the next five days, 10 mg/body of CDDP and 250 mg/body of 5-FU using arterial infusion were administered. It was discontinued for two days, as one course, and 4 courses were basally administered. The duration of the administration was 24 or 6 hours/day. Side effects consisted of nausea or loss of appetite for 7 (50%), suppression of bone marrow for 3 (21%), and they disappeared after the agents were discontinued. However, there were 3 patients with gastro-duodenal ulcer, so careful follow-up was necessary. The efficacy rate was 64% and two-year survival rate was 57% and thus this treatment seemed to be effective. Further study on the duration and dose of the administration is necessary to improve the therapeutic effect and QOL.

[Cineradiographical significance for diagnosis and treatment of thrombosed Björk-Shiley prosthesis in the aortic position].

In the periods between February 1973 and December 1987, 377 Björk-Shiley valve prostheses have been implanted in the aortic position in our institute. The maximum opening angle of the prosthesis have been cineradiographically measured in 30 cases. The maximum opening angle of the convexo-concave valve having an opening angle of 60 degree (CC 60) was measured as 58.8 +/- 1.9 degree and that of the monostrut valve having an opening angle of 70 degree was 69.4 +/- 2.1 degree. During this period we have experienced 6 cases of thrombosed Björk-Shiley prosthesis. They have shown restriction of the opening from 26 to 58.9 degree and restriction of the closing from 9.2 to 41.8 degree. Thrombolytic treatment was successful in case with thrombosed Björk-Shiley prosthesis which showed restriction of the opening angle on cineradiogram. 4 cases with restriction of the closing angle on cineradiogram were treated operative thrombectomy. Three of them have had uneventful reoperative course in the follow up period of 8 years. We believe that cineradiography is very useful for not only diagnosis but also decision of management for thrombosed Björk-Shiley prosthesis in the aortic position.

The surgical treatment of aortic regurgitation secondary to aortitis.

We describe the operative and perioperative management of 11 patients with aortic regurgitation due to aortitis. All patients required aortic valve replacement because of severely uncoapted cusps secondary to dilatation of the ascending aorta. The right coronary ostium was narrowed in 5 patients and consequently necessitated a smaller coronary tip for the administration of cardioplegic solution. To implant the prosthetic valve, pledgeted 2-0 Tevdek sutures were placed through the aortic valve annulus either from the ventricular side or from outside the aortic wall. Steroids were administered to 4 patients preoperatively and 8 patients postoperatively. Postoperative dehiscence of the prosthesis was seen in 1 of the 3 patients not given any steriods. We conclude that it is important to arrest the inflammatory reaction before operation and if the aortic valve must be replaced, to reinforce the implanted prosthesis with pledgeted sutures. Also, we suggest the possible importance of steroid therapy.

[Surgery of the patients on anticoagulants following prosthetic valve replacement].

The surgical operations including 5 cholecystectomies, gastrectomy, and graft implantation for abdominal aortic aneurysm were performed on 7 patients 2 to 98 months after valve replacement. Sodium warfarin was routinely used in an amount to reduce the prothrombin activity in a range of 20-30% normal by thrombotest. In all cases, anticoagulants were reduced in doses gradually in the period of 4 to 15 days proceeding to the operation. Heparin therapy was instituted for the prevention of thromboembolism, when prothrombin activity recovered to 50% normal by thrombotest, in 5 of 7 cases. Heparin therapy was interrupted just prior to operations and it was reinstituted soon after operations in 6 cases. Heparin therapy was maintained by continuous intravenous infusion to produce ACT of 130 to 150 seconds. Heparin therapy was stopped when prothrombin activity reached a therapeutic level with sodium warfarin. There were two episodes of hemorrhage required blood transfusion, observed in patients receiving heparin therapy, but there was no thromboembolism. We believe that our method which minimizes the nonanticoagulated time appears safe and effective in patients with prosthetic heart valves who require noncardiac operations.