[Postoperative analgesia for hepatic cryosurgery].

BACKGROUND: Hepatic cryosurgery is an alternative therapeutic choice for patients who are not eligible for surgical liver resection. As this procedure sometimes causes postoperative bleeding tendency, we investigated indication of intravenous patient-controlled analgesia (IVPCA) after this surgery. METHODS: We measured pre- and postoperative platelet counts, coagulation profile and postoperative pain with IVPCA in 8 patients. RESULTS: Platelet counts decreased from 9.83 +/- 5.38 (x 10(3) x ml(-1)) to 5.91 +/- 4.56 (x10(3) x ml(-1)) postoperatively (P<0.01) and the maximum relative decrease was 72%. Platelet counts reached the maximum depression from 1 to 3 POD and in two patients it did not recover by 7 POD. Percentage of prothrombin activity decreased from 79.5 +/- 10.4 to 65.9 +/- 13.2 (P<0.01), with the nadir observed from 0 POD to 2 POD. In this study it was difficult to predict the extent of postoperative bleeding tendency beforehand. IVPCA with morphine provided adequate analgesia at rest. Althogh pain on moving seemed rather difficult to treat in two patients, IVPCA also helped patients walk with VAS score less than 55 mm in other patients. CONCLUSIONS: Considering the risk of bleeding tendency and epidural hematoma, we recommend IVPCA with opioid for postoperative pain in patients after hepatic cryosurgery instead of epidural analgesia and non-steroidal anti-inflammatory drugs.

[Evaluation of perioperative management of seven patients with pulmonary artery sling in recent seven years].

BACKGROUND: Pulmonary artery sling (PA sling) is a rare vascular anomaly in which the left pulmonary artery arises from the right pulmonary artery. It can cause compression of trachea. Due to its rarity, risk factors influencing postsurgical outcome are still unclear. The purpose of our study is to investigate past cases of PA sling to clarify risk factors. METHODS: We investigated 7 patients who had undergone one-stage operation of PA sling from 2001 to 2007. Hospital stay, ICU stay and length of artificial ventilation are set as primary outcome. Patients' weight, range of tracheal stenosis, operation time, cardiopulmonary bypass time, presence of tracheal stenosis, bronchial anomaly, preoperative intubation, intracardiac anomaly and postoperative re-intubation were compared. RESULTS: In-hospital mortality was none. Two cases in patients with tracheomalacia were re-intubated. Concomitant tracheoplasty was performed in six patients. Two patients with intracardiac anomaly underwent cardiac operation. No factor except tracheomalacia affected primary outcome. CONCLUSIONS: We need more cases to clarify factors affecting outcome of patients with PA sling. However, existence of tracheomalacia is found to be a risk factor of longer artificial ventilation.

Unmet supportive needs of cancer patients in an acute care hospital in Japan--a census study.

PURPOSE: Little research has been done on supportive needs of cancer patients in acute hospitals in Japan. This study aims to comprehensively assess the unmet supportive needs of hospitalized cancer patients, as well as literacy and utilization of appropriate professional care. METHODS: All cancer patients (aged 20 to 80 years) who were hospitalized in a university hospital in Tokyo during the designated 3-day period between September 1 and October 31, 2007 were recruited for participation in the study. The M.D. Anderson Symptom Inventory, Brief Cancer-Related Worry Inventory, and Hospital Anxiety and Depression Scale were administered. Patients' knowledge and use of relevant services were evaluated. The results were compared with those of non-cancer patients in the same treatment settings. RESULTS: A total of 125 cancer patients and 59 non-cancer patients were enrolled. Cancer patients and non-cancer patients equally suffered from physical symptoms (15-26% had severe appetite loss, 18-19% had severe dry mouth, and 16-22% had severe pain); however, psychological distress of cancer patients exceeded that of non-cancer patients (28.0% vs 8.5%; p ≤ 0.05). Severe psychological distress was associated with severe worry about future prospects or interpersonal and social issues and presence of two or more severe symptoms. Two thirds of the patients with severe psychological distress knew about the psychiatric division, but only one third actually sought treatment. CONCLUSIONS: Needs related to psychological issues were more prevalent among cancer patients than among non-cancer patients, despite a similar level of physical distress. Special attention should be paid to cancer patients who worry over future prospects or interpersonal and social issues, and those who have two or more severe symptoms.