Analgesic efficacy of ropivacaine wound infusion after laparoscopic colorectal surgery

PURPOSE: Local anesthetic wound infusion has been previously investigated in postoperative pain management. However, a limited number of studies have evaluated its use in laparoscopic colorectal surgery. This study aims to evaluate whether ropivacaine wound infusion is effective for postoperative pain management after laparoscopic surgery in patients with colorectal cancer. METHODS: This prospective study included 184 patients who underwent laparoscopic surgery for colorectal cancer between July 2012 and June 2013. The patients were grouped as the combined group (intravenous patient-controlled analgesia [IV-PCA] plus continuous wound infusion with ropivacaine, n = 92) and the PCA group (IV-PCA only, n = 92). Efficacy and safety were assessed in terms of numeric rating scale (NRS) pain score, opioid consumption, postoperative recovery, and complications. RESULTS: The total quantity of PCA fentanyl was significantly less in the combined group than in the PCA group (P < 0.001). The NRS score of the combined group was not higher than in the PCA group, despite less opioid consumption. There were no differences between groups for postoperative recovery and most complications, including wound complications. However, the rate of nausea and vomiting was significantly lower in the combined group (P = 0.022). CONCLUSION: Ropivacaine wound infusion significantly reduced postoperative opioid requirements and the rate of nausea/vomiting. This study showed clinical efficacy of ropivacaine wound infusion for postoperative pain control in colorectal cancer patients undergoing laparoscopic surgery.

Investigation of Clinical Manifestations in Korean Colorectal Cancer Patients

PURPOSE: Early diagnostic work-up in patients with clinical symptoms of colorectal cancer (CRC) is important to achieve good treatment results. In this study, we investigated clinical symptoms when a diagnosis of CRC was made in patients who had a surgical resection, especially focusing on the relevance of constipation to CRC. METHODS: The clinical symptoms of 17,415 CRC patients who had curative surgery from January 2010 to December 2012 were collected from 24 training hospitals of surgery. RESULTS: The number of symptomatic patients before the diagnosis of CRC was 11,085 (63.7%). Hematochezia or melena, abdominal pain, anemia, and constipation were more often found in female than male patients while bowel habit change was more common in male patients. Considering age, bowel habit change and hematochezia or melena were more common in patients younger than 60. Anemia and constipation, however, were more common in patients older than 60. According to the group classification based on age, patients older than 60 had experienced more constipation (P = 0.049). Moreover, patients with constipation tended to have a more advanced disease status (P < 0.001). CONCLUSION: In patients who had surgery due to CRC, bleeding, abdominal pain, bowel habit change and constipation were the most frequent symptoms before diagnosis. Although whether or not constipation is a cause of CRC is unclear, it is one of the important clinical symptoms that presents in patients with CRC, and patients with a symptom of constipation tend to present with a more advanced CRC stage.

The Discriminating Ability of a Prognosis According to the TNM, Okuda, CLIP, JIS, and BCLC Staging Systems for Hepatocellular Carcinoma

PURPOSE: There is yet no ideal single staging system for hepatocellular carcinoma (HCC). The aim of this study was to analyze HCC survival times according to the TNM, Okuda, CLIP, JIS, and BCLC staging systems and their prognostic discrimination ability. METHODS: A retrospective analysis of medical records and statistical data from the Korean statistical information service was done for HCC patients diagnosed at Bundang CHA hospital between June, 1992 and February, 2009. RESULTS: During follow-up, 121 (72%) of 168 people died and 1, 3 and 5 year overall survival rates were, respectively, 58%, 35% and 25%. In the analysis of discriminative ability of each staging system, the CLIP staging system showed the highest LR chi-square value, and the lowest AIC value (p<0.05). Therefore, the CLIP staging system appears to be superior to the other systems. CONCLUSION: Of the 5 staging systems in this study, the CLIP staging system was superior to the other systems, but the results of many other studies from different countries have varied. It is necessary to establish the staging system suitable for each country's actual circumstances.

A Case of Surgical Treatment of Nesidioblastosis with Hyperinsulinemic Hypoglycemia in an Adult

Nesidioblastosis is a rare disorder, and it usually considered as a cause of neonatal hyperinsulinemic hypoglycemia. A 35 year-old-woman with hyperinsulinemic hypoglycemia was admitted in an unconscious condition. Abdominal CT, pancreas MRI and celiac angiography with an intra-arterial calcium stimulation test revealed a suspicious insulin-producing tumorous lesion in the head of pancreas. The patient underwent enucleation of the pancreas head tumor under the initial diagnosis of insulinoma. However, the tumor was confirmed histologically as nesidioblastosis that showed ductoendocrine proliferations and numerous small endocrine cell groups. Nesidioblastosis is classified into a focal type and a diffuse type, which are characterized by different clinical outcomes. The patient in our case showed a normal blood glucose level after operation, which is often the case for the focal type. Herein, we report this very rare case of adult nesiodioblastosis that was successfully treated by surgical resection.

A Case of the Primary Small Cell Carcinoma of the Pancreas

A 57-year-old man with severe abdominal pain was admitted to our hospital. Chest PA and simple abdominal X-ray revealed no specific findings, but the abdominal-pelvis CT scan showed a 5cm sized multiloculated cystic tumor originating from the pancreatic head and a 3.2cm sized hepatic lesion that was suspected to be a metastic lesion. A radical operation was not able to be performed because of peritoneal metastasis and gastrocolonal infiltration. Only open lymph node biopsy was done and it revealed metastatic small cell carcinoma. Long-acting octreotide and gemcitabine was administered to the patient, but there was no therapeutic response. The tumor grew very rapidly to 26cm in size and the patient died 2 months later from his first hospital day. Necropsy was performed, and the pathologic finding of the resected mass was confirmed to be small cell carcinoma, the same as the result of the previous lymph node biopsy.

Comparison of Vitrification and Slow Freezing-thawing Method on 1-cell Zygotes / 대한불임학회지

OBJECTIVE: This study was conducted to examine the effect of vitrification on the survival and in vitro development of mice 1-cell zygotes. METHOD: Effects of exposure to vitrification solution and vitrification, with different concentrations of the cryoprotectant solution, were examined. The 1-cell zygotes were also subjected to a slow freezing- thawing method to compare with vitrification method. Solution composed of ethylene glycol (6.0 M, 5.0 M, 4.0 M) and sucrose (1.0 M) were used as cryopropectant. The experiments employed the method loading the embryos on electron microscope grids. RESULTS: I. The effects of exposure in vitrification solution 1-cell zygotes were non-toxic at all concentrations of the vitrification solution showing the survival rate between 88.1% and 97.5%. Development into 2-cell was more successful in the higher concentrations of the vitrification solution. Therefore, higher concentrations of the vitirification solution do not seem to cause any problems in vitrification procedure. II. The effects of vitrification method 1-cell zygotes showed the survival rate between 78.8% and 92.4%. The lowest and the highest survival rate was observed in the 6.0 M and 4.0 M vitrification solution, respectively. 2-cell development rates varied from 77.6% to 91.3%. Blastocyst development rate was shown highest in 5.0 M and the lowest in 4.0 M solution. Therefore, the highest 2-cell and blastocyst development rate was observed in 5.0 M solution. III. Comparison of vitrification and slow freezing-thawing method on 1-cell zygotes This experiment showed that 1-cell zygotes had the highest survival and development rates in 5.0 M vitrification solution. Vitrified group of 1-cell zygotes, in the 5.0 M vitrification solution, were compared with the group processed in slow freezing-thawing method. The development rate into 2-cell and blastocyst as well as the survival rate were higher in the vitrified group than in the slowly freezed group. CONCLUSION: 1. The results demonstrate that the best cryoprotectant is a 5.0 M vitrification solution for 1-cell zygotes. 2. Vitrification method significantly increases the survival rate of the 1-cell zygote and its development into 2-cell and blastocyst. Equilibration and exposure time during the vitrification was remarkerbly short in this experiment. Total time, from the exposure to vitirification solution to storage in the liquid nitrogen, was taken only 90 seconds. In contrast, the slow freezing-thawing method have taken more than four hours. Taken together, we presume that the overall time used for the procedure contributes to the results as an important parameter. 3. The loading of 1-cell zygotes on the EM grid is technically more simple and takes less time than the straw or cryo vial method.