[The obstruction of a port catheter during the induction of anesthesia].

A 44-year-old woman receiving home hyperalimetation with an implanted port catheter, was scheduled to undergo resection of ovarian cyst and adhesiotomy. For the induction of anesthesia, fentanyl 0.05 mg, thiopental sodium 200 mg, saline 5 ml and vecuronium 10 mg were given through the port catheter. Although she fell asleep, she kept breathing spontaneouly. It was not possible to give any further drugs through this port catheter, suggesting obstruction of the catheter. The endotracheal intubation was assisted with sevoflurane 5% and suxamethonium 80 mg chloride given through the peripheral vein. Five ml of saline used to flash out thiopental sodium before the administration of vecuronium blomide was not considered to be adequate. An experiment was conducted to investigate how much saline is necessary to wash out completely the drug given previously. The results suggest that more than 10 ml of saline should be given through the port catheter. Various types of central venous catheters are being used. Precise knowledge of each catheter is necessary to use this indispensable central vein route, especially at the crucial timing, such as the induction of anesthesia.

[A case of peritoneal dissemination of gastric cancer successfully treated by irinotecan combined with cisplatin].

We report a case of a 59-year-old man with advanced gastric cancer. Distal gastrectomy with lymph node dissection (D1) was performed. Pathological staging was IV (T3N1CY1), and the operation resulted in curability C. The serum CA19-9 level before the operation was 201 U/ml, and it did not normalize 3 months after the operation. Postoperative chemotherapy (TS-1, 100 mg/day) was performed. Because the tumor markers such as CEA and CA19-9 level elevated 5 months after the operation, triweekly docetaxel therapy and TS-1 administration (days 1-14) were performed. We disbontinued this therapy after 2 courses due to adverse reactions, such as leukopenia (grade 4) and liver dysfunction (grade 2). Peritoneal dissemination was diagnosed by the appearance of ascites and thickness of the peritoneum 11 months after the operation. So the patient was treated with a biweekly combination chemotherapy of irinotecan (CPT-11 60 mg/m2) and cisplatin (CDDP 30 mg/m2). Eight courses of this therapy induced partial remission and normalization of the serum CEA level. No major adverse reaction to this therapy was observed. The partial remission and good patient's QOL were achieved during follow-up 7 months after the administration of CPT-11 plus CDDP. This case suggests that patients with recurrent peritoneal dissemination of gastric cancer could benefit from CPT-11 with CDDP combination therapy as a second-line or third-line treatment.