Uracil with ftorafur and low dose oral folinic acid in advanced colorectal cancer.

BACKGROUND: Low dose oral Folinic acid was used together with uracil with ftorafur (UFT) producing some response with low toxicity in advanced colorectal cancer. However, the 28 day regimen produced 20 per cent severe (grade III, IV) diarrhea. This study required 21 days' treatment to evaluate the response rate and toxicity in advanced colorectal cancer. METHOD: UFT 300 mg/m2/day together with oral Folinic acid 7.5 mg/dose for 21 days with 7 days rest were required to treat 28 cases of recurrent or metastatic colorectal cancer. RESULTS: Partial response was seen in 13.6 per cent of 22 evaluable cases and minimal response seen in 18.2 per cent. The majority (77%) of these patients had previously been treated with 5-fluorouracil (5-FU). These results are comparable to other studies. Toxicity was low with 3.3 per cent grade III, IV diarrhea. CONCLUSION: This regimen produced some activity in metastatic colorectal cancer with low toxicity.

Anesthesia and laparoscopic adrenalectomy for primary aldosteronism.

Adrenalectomy is the curative treatment of primary aldosteronism or Conn's syndrome. Laparoscopic adrenalectomy, a new method, should result in less pain and shorter hospitalization. We reported 25 patients who received anesthesia and laparoscopic adrenalectomy from 1995-1999. There were 17 females and 8 males. The mean age was 41.9 years (range 25-59). Ninety-six per cent had hypertension, 76 per cent had weakness of the extremities. When these patients sought medical care, their serum potassium and bicarbonate were 2.4 and 30.9 mEq/l respectively. Before operation, after treatment with spinorolactone, they were 4.3 and 24.4 mEq/l respectively. Associated diseases and cardiovascular abnormalities were reported. General anesthesia was the anesthetic technique of choice. Laparoscopic adrenalectomy was described in detail. Sixteen patients had adenomas on the left adrenal gland, 9 were on the right. Twenty-four patients had unilateral adrenalectomy, one had enucleation of the tumor. The size of the adenoma was 1.8 cm (range 1-3). There was no morbidity or mortality. All patients were discharged on the third postoperative day.

Surgery and anesthesia for pheochromocytoma--a series of 40 operations.

Pheochromocytoma is a catecholamine-producing tumor which can be life-threatening. A series of 40 operations in 39 pheochromocytoma patients at a tertiary hospital in Thailand from 1976 to 1997 was reported. The patients were 30 females and 9 males; aged 7-73 years. One man had 2 operations 5 years apart. The most common symptoms and signs were palpitation, headache and hypertension. Preoperative management consisted of control of blood pressure and restoration of intravascular volume by using prazosin, an alpha adrenergic blocker. New imaging techniques have improved the ability to localize the tumors; 20 were found in the right adrenal glands, 14 in the left, 1 patient had bilateral tumors, 4 in Organs of Zuckerkandl and 1 patient had metastatic liver nodules. The operative procedures were 39 laparotomies and 1 laparoscopic surgery. The surgical and anaesthetic procedures were presented, and nitroprusside was used to control intraoperative blood pressure. Removal of tumors was successful in all cases except for 1 mortality due to injury of the liver and massive blood loss. Other complications were postoperative pulmonary edema and renal vein thrombosis. One patient had MEN type 2 and five cases were malignant. Pheochromocytoma can be cured by surgery, but cooperation among surgeons, anesthesiologists and internists is very important.

A double-blind comparative study of glucolyte-2 with conventional infusion in postoperative surgical and trauma patients.

To investigate the effectiveness of a new electrolyte solution, Glucolyte-2, which contains 7.5 per cent glucose, electrolytes, and a trace element (zinc), 12 postoperative surgical and 21 trauma patients who were unable to receive enteral feeding were given either Glucolyte-2 or the conventional infusion containing 5 per cent glucose and electrolytes as a control in a double-blind fashion. The zinc balance in surgical patients given Glucolyte-2 was 2.648 +/- 864 micrograms/day, whereas that in patients given the conventional infusion was -2,972 +/- 1,385 micrograms/day (mean +/- S.E.M.). The positive zinc balance after Glucolyte-2 administration was significantly higher than that after the conventional infusion (p less than 0.001). Similarly, a positive zinc balance (3,464 +/- 422 micrograms/day) was obtained in trauma patients given Glucolyte-2, while in trauma patients given the conventional infusion, the zinc balance was negative (-1,737 +/- 491 micrograms/day), which was significantly lower (p less than 0.05). Magnesium and phosphate balances were negative in surgical and trauma patients in both infusion groups. However, the balance in patients given Glucolyte-2 was better than in those patients given the conventional infusion. The differences of the balance for magnesium in surgical patients and trauma patients were significant (p less than 0.001 and p less than 0.01, respectively). The differences of the balance for phosphate in surgical and trauma patients were also significant (p less than 0.01). It is indicated that the infusion of Glucolyte-2 containing zinc and other electrolytes will be more favorable than the conventional infusion in both surgical and trauma patients.