Functional Outcomes of Patients Treated with Intensive Medications for Bowel and Pain Control for Low-Lying Rectal Cancer Who Received Preoperative Chemoradiotherapy.

PURPOSE: The aim of this study was to assess the functional outcomes of patients treated with intensive medications for bowel and pain control for low-lying rectal cancer who received preoperative chemoradiotherapy (CRT). METHODS: The inclusion criterion was sphincter-preserving surgery following CRT for T3 middle and low rectal cancer. Postoperative defecation control was conducted using calcium polycarbophil and loperamide, and anal pain control was conducted using oxycodone hydrochloride hydrate. The functional outcomes were determined by an annual questionnaire after stoma closure. RESULTS: Of 64 patients evaluated, 33 were reconstructed using the double stapling technique (DST) and 31 were reconstructed using the intersphincteric resection (ISR) technique. The median Visual Analogue Scale at ISR was improved from 7 to 1.5 at 1 year after surgery. The median Wexner scores were 6.0, 6.0, 5.0 and 5.0 for DST and 14.5, 12.0, 10.0 and 8.0 for ISR for the first 4 years, respectively. The only independent predictor of a poor bowel function (Wexner score >10) according to a multivariate analyses was pelvic infection (OR 3.994, 95% CI 1.235-13.52, p = 0.021), while ISR was not a predictor. CONCLUSIONS: Anal pain following ISR can be controlled with oxycodone hydrochloride hydrate therapy. ISR is feasible following CRT for low-lying rectal cancer.

<b>Efficacy of Mokuboito in Patients with Severe Intractable Heart Failure</b> / 日本東洋医学雑誌

Although western medical treatment for heart failure has dramatically improved, limitation still exists where such treatment together with mechanical support fails to manage heart failure. It is unclear whether the addition of Kampo medicine to standard recommended therapy can improve clinical manifestations. To address this issue, we retrospectively evaluated the effects of Mokuboito used in 12 consecutive heart failure patients from April 2013 to April 2015 by analyzing endpoints such as symptoms, BNP concentration, and left ventricular ejection fraction (LVEF). Mokuboito significantly decreased plasma BNP concentration from 796.8 ± 830.8 to 215.6 ± 85.5 pg/ml (p < 0.01) and improved symptoms. There were no significant differences in other parameters including LVEF. In conclusion, the present study suggests that Mokuboito is a useful treatment on top of the standard heart failure medication in severe heart failure patients.