Postoperative management using intensive patient-controlled epidural analgesia and early rehabilitation after an esophagectomy.

PURPOSE: Patient-controlled epidural analgesia (PCEA) was developed for use after surgery for thoracic esophageal cancer to relieve wound pain, introduce early rehabilitation, and provide an uneventful postoperative recovery. METHODS: This retrospective study investigated 22 patients who underwent esophageal surgery to determine the efficacy of postoperative management with PCEA. In the PCEA group (n = 12), patients had two epidural catheters inserted to cover both the thoracic and abdominal incision with a patient-controlled bolus capability. RESULTS: Postoperative mechanical ventilation was administered in all cases in the control group (n = 10). On the other hand, this was only necessary in two patients in the PCEA group. The amount of time the patients stayed in the intensive care unit and the hospital was significantly shorter in the PCEA group than in the control group (P < 0.001 and P < 0.01, respectively). Respiratory complications occurred in four patients in the control group, and none in the PCEA group. The mean number of supplemental analgesics administered for breakthrough pain until the 7th postoperative day was 5.5 in the control group, and 1.3 in the PCEA group (P < 0.001). CONCLUSIONS: Early rehabilitation is facilitated with intensive PCEA, while it also improves postoperative management and reduces hospitalization after esophageal surgery.

Clinical outcomes of FOLFOX/FOLFIRI for the Japanese patients with far-advanced or recurrent colorectal cancer.

PURPOSE: Oxaliplatin, Irinotecan, 5-fluorouracil and leucovorin are commonly used to treat advanced colorectal cancer in Western countries. Here, we investigated the efficacy and safety of FOLFOX/FOLFIRI in Japanese colorectal cancer patients. METHODS: FOLFOX4, modified FOLFOX6 and FOLFIRI was administered to a total of 23 patients with far advanced or recurrent colorectal cancer in our institute. Tumor response rate and toxicity were analyzed with these patients. RESULTS: Partial response and stable disease was observed in 28.6% of patients, respectively. There was no therapy-related death. Neutropenia was observed in 12 cases (52.2%), anemia was in 12 cases (52.2%) and thrombocytopenia was in 6 cases (26.1%), respectively; among them, 9 patients (39.1%) experienced a Grade 3 of bone marrow suppression. Fatigue was observed in 8 cases (34.8%), nausea/vomiting was in 4 cases (17.4%), diarrhea was in 4 cases (17.4%) and neurotoxicity was in 8 cases (34.8%), respectively. All nonhematological toxicities were Grade 1 or 2. CONCLUSION: FOLFOX/FOLFIRI can contribute to efficacy and safety in cases of advanced colorectal cancer. In order to evaluate the long-term clinical results in Japanese patients, prospective controlled studies are urgently called for.

Complete mole coexistent with a twin fetus.

We report two cases of a complete hydatidiform mole coexistent with a live fetus diagnosed by DNA polymorphism analysis. A 27-year-old woman revealed symptoms of pre-eclampsia and ultrasound showed multicystic tumor and placenta coexistent with a live fetus at 16 weeks' gestation. The placenta with partly hydropic change and the fetus without anomaly were consequently evacuated. Another 30-year-old woman had a multicystic mass attached to a normal placenta with a 20-week live fetus on ultrasound examination. A hysterotomy was carried out because of persistent bleeding due to placenta previa. In both cases, DNA was extracted from the placental tissue and the tumor, as well as from maternal and paternal blood. Genetic analysis demonstrated that the placental tumor consisted of only paternal origin, which is consistent with the diagnosis of complete hydatidiform mole.

[A case of aged recurrent breast cancer with multiple lung metastases responding to examestane monotherapy].

An 85-year-old woman suffering from an angina attack was admitted to our hospital, and diagnosed with multiple lung metastases by CT scan. Because she was extremely aged with a long disease-free period of over 12 years, and without any life-threatening state despite multiple lung metastases, she received hormonal therapy. Examestane was considered one of the most-effective hormonal drugs for metastatic breast cancer. The efficacy of the treatment was definite: the multiple metastatic lesions showed a partial response after 5 months'treatment, and reached a complete response after 10 months'treatment. After 8 months in the complete response state, CT scan revealed progressive disease. Fortunately, the lung metastatic lesions were only slowly progressive, and she has no symptoms now. There was no side effect except for complication of subdural hematoma. Examestane is considered highly effective for metastatic breast cancer and well tolerated by an aged patient like this case.