A prospective observational study of recall of discomfort on tracheal extubation after general anaesthesia.

Background: Tracheal extubation is a critical stage in the management of general anaesthesia during which serious complications may occur. Immediately before extubation, patients often exhibit signs that suggest that they are awake and experiencing discomfort. There is concern that patients may retain such memories of the extubation process. However, previous studies have not examined patient recall of extubation in detail. We therefore investigated the frequency of recall of discomfort during extubation, as well as first orientation to place, and other recollections upon emerging from general anaesthesia. Methods: In a prospective observational study, 818 patients were interviewed during routine post-anaesthesia rounds on the day after general anaesthesia. The primary outcome was the proportion of patients recalling discomfort during extubation. The secondary outcome was the location of orientation to place upon emerging from general anaesthesia. Results: Recall of discomfort during extubation was uncommon, at 1.1% (n=9; 95% confidence interval [CI]: 0.5-2.1%). Only 3.1% of patients recalled the extubation process at all (n=25; 95% CI: 2.0-4.5%). The first orientation to place was most commonly in transit to a ward, in 41% of cases (n=337; 95% CI: 38-45%). Conclusions: Recall of discomfort during extubation appears to be rare, and the great majority of patients may not retain any memory of the extubation process. This information may be used to reassure patients and guide extubation practices for anaesthetists. Clinical trial registration: UMIN Clinical Trials Registry (UMIN000046136).

[A case of gastric endocrine cell carcinoma with neck lymph node metastasis resected after neoadjuvant chemotherapy].

A relatively rare case of gastric endocrine cell carcinoma was reported. The prognosis of this disease appears to be very poor due to its rapid rate of growth and invasiveness. A 75-year-old woman underwent a gastric endoscopy because the patient complained of an appetite loss. A gross Borrmann 3 type lesion in the greater curvature of the fornix was found. Biopsy specimens showed endocrine cell carcinoma. Abdominal CT examination revealed metastases in left neck and paraaortic lymph nodes. The serum sample showed an elevation of NSE level to be 53. A combination chemotherapy was performed using cisplatin and etoposide, which resulted in remarkable reduction of the main tumor two months later. The total gastrectomy associated with D2 lymph node dissection was performed. However, abdominal tumor was observed again in a month and it progressed rapidly. No clear response to the chemotherapies with cisplatin/etoposide or paclitaxel was found. The patient died 5 months after the operation.

[A case of liver and lung metastases of rectal cancer responding well to 5-FU hepato-arterial infusion (HAI) with combined use of oral UFT].

We have studied the pharmacokinetics of 5-FU hepato-arterial infusion (HAI) with combined use of oral UFT for colorectal cancer cases previously. The plasma 5-FU concentration in cases of 5-FU HAI plus UFT is 1.5-6 times as high as with 5-FU HAI only. We report a rectal cancer case with liver and lung metastases treated successfully with this protocol. A 75-year-male underwent low anterior resection for rectal cancer as Rab, 3.5 x 3 cm, well, ai, n2, P0, H3, M1 on March 26, 2002. For synchronous hepatic and lung metastases, he received weekly 5-FU 1,000 mg HAI, UFT 4T 2 x postoperatively. As a result, liver and lung metastases disappeared over 6 months. We recommend weekly 5-FU HAI with combined use of UFT, which can be more effective not only for liver metastases but also for extra-hepatic lesion of colorectal cancer.

[Complication after self expandable metallic stent for esophageal cancer].

Major complications after placement of esophageal stent and airway stent were reviewed and evaluated. Four patients, including two patients with perforations and two patients with fistula formation, developed major complications after placement of a self expandable metallic stent. Two patients underwent additional radiation to improve stricture after stent placement. In one patient, stent placement was selected to improve esophageal stricture that occurred after radical radiation therapy. In one patient, migration of stent into the lesion caused a perforation. It can be concluded that additional radiation after stent placement increases the risk of complication. Stent migration also can lead to the risk of perforation.