[Concurrent chemoradiation therapy for advanced cervical cancer].

In 2003, we began a clinical application of concurrent chemoradiation therapy (CCR) in patients with cervical cancer in our hospital. We analyzed 14 cases of advanced cervical cancer in stages IIa through IIIb by FIGO classification. Tumor size of the uterine cervix ranged from 1.5 cm to 8.0 cm in diameter. Patients received radiation therapy (50 Gy of external beam radiotherapy for pelvis and 20 Gy of high-dose rate intracavitary brachytherapy) combined with chemotherapy. Cisplatin was administered intravenously every 3 weeks at a dose of 70 mg/m(2) during the radiation therapy. In two cases, CCR was stopped because of the side effects. One case developed acute renal failure and another suffered intolerable exhaustion. As for the antitumor effects of CCR, the response rate was 75% (CR 58.3%,PR 16.7%). At the end of the CCR, 10 of 12 patients (83.3%) were negative for viable cells by cytology or biopsy of the uterine cervix. The grade 3 adverse effects were leukopenia, diarrhea and anemia. There was no statistical difference in the overall survival between CCR and radiation therapy alone. The CCR response rate in patients with paraaortic lymph node swelling (suspected metastasis) was low, and they had a poor prognosis. Further examinations for the long-term survival benefit of CCR are necessary.

Epidural analgesia prevents endotoxin-induced gut mucosal injury in rabbits.

In the present study, we evaluated the effect of epidural analgesia on the alterations of gut barrier function elicited by endotoxin in rabbits. After the placement of an epidural catheter, 28 male rabbits were randomized into either 0.5% lidocaine (group E) or saline (group C) group. The solutions (0.4 mL/kg) were epidurally injected, followed by continuous infusion (0.1 mL . kg(-1) . h(-1)) throughout the study period. Under a continuous infusion of lipopolysaccharide (15 microg . kg(-1) . h(-1)), mean arterial blood pressure, intramucosal pH, and plasma thrombomodulin concentrations were measured. At 4 h, mean arterial blood pressure was lower (P < 0.05), intramucosal pH was higher (P < 0.01), and the progression of hemodilution more profound (P < 0.05) in group E versus group C, whereas plasma thrombomodulin levels were increased to a similar extent between the groups. With less wet-to-dry weight ratio of ileum, histopathological injury scores of gut mucosa were significantly less in group E versus group C (P < 0.01). In a separate series of experiments (n = 10 each group), mucosal permeability in group E was significantly less compared with group C (P < 0.05). Collectively, these studies showed that despite a significant decrease of perfusion pressure and arterial oxygen content, epidural analgesia minimized endotoxin-induced functional and structural injury of gut mucosa possibly through endothelium-independent mechanisms.

[New monitoring method for the pudental nerve during surgery: cases of intraoperative monitoring for lumbo-sacral lipomeningocele].

We carried out intraoperative monitoring of the pudental nerve while separating vertebral spinal tumors from the spinal cord in five patients, including four infants. Although monitoring using a manometer or needle electrodes has been reported, monitoring done with disk electrodes to ascertain the compound muscle action potential (CMAP) of the external sphincter muscle has not been yet attempted. Prior to the surgical procedure, we locate a point suitable for CAMP recording of the muscle. In our recent study, we determined that maximum action potentials were recorded in the part with the greatest depth from the individual anal verge. Therefore, the depth of the anal canal was preoperatively measured for the manometry method, and sphincter electrodes currently on the market were refigured to suit the infant's anal canal. After the two procedures described above, we were able to preserve the pudental nerves intraoperatively. The postoperative neurological findings of all five patients were unchanged. We introduce here this new method of intraoperative monitoring for preserving the pudental nerve.

Olprinone, a phosphodiesterase III inhibitor, reduces gut mucosal injury and portal endotoxin level during acute hypoxia in rabbits.

BACKGROUND: Preservation of gut integrity has become a therapeutic goal to obviate bacterial translocation in the critically ill. The authors examined whether olprinone, a phosphodiesterase III inhibitor, protected functional and structural integrity of gut mucosa against acute progressive hypoxia. METHODS: Thirty-two animals were randomly allocated to a control group (n = 12), a low-dose group (0.2 microg x kg-1 x min-1 olprinone; n = 10), or a high-dose group (0.6 microg x kg-1 x min-1 olprinone; n = 10) after preparatory surgery. Ascending aortic and portal blood flow, intramural pH of the ileum, and portal endotoxin levels were measured at normoxia and through three stages of progressive hypoxia (fraction of inspired oxygen = 0.17, 0.13, and 0.10). RESULTS: At normoxia, ascending aortic flow in the high-dose group was approximately 20% higher than in the control and low-dose groups. During progressive hypoxia, both ascending aortic and portal flow in the control group were depressed, whereas olprinone infusion attenuated such alterations and redistributed blood to the splanchnic area in a dose-dependent manner. On the contrary, the reduction of intramural pH of the ileum and the elevation of portal endotoxin levels observed in the control group were significantly minimized in both the low- and high-dose groups to a similar extent during acute hypoxia. Histopathologic alterations of gut mucosa observed in the control group were minimized by olprinone infusion dose-independently, accompanied by reduction of mortality rate of the animals. CONCLUSIONS: Olprinone slows progression of intestinal mucosal acidosis and gut barrier dysfunction, concurrently with preservation of microscopic structures, through both flow-dependent and -independent mechanisms under acute hypoxia. Such properties of olprinone may serve to protect the host under insult.