Efficacy and Cost-effectiveness of Pegfilgrastim for Preventing Febrile Neutropenia During Docetaxel, Cisplatin, and 5-Fluorouracil Therapy for Esophageal Cancer.

BACKGROUND/AIM: The docetaxel, 5-fluorouracil, and cisplatin (DCF) regimen is an effective form of chemotherapy for advanced esophageal cancer. However, the incidence of adverse events, such as febrile neutropenia (FN), is high. This study retrospectively examined whether pegfilgrastim treatment reduces FN development during DCF therapy. PATIENTS AND METHODS: This study evaluated 52 patients who were diagnosed with esophageal cancer and underwent DCF therapy at Jikei Daisan Hospital, Tokyo, Japan, between 2016 and 2020. They were divided into non-pegfilgrastim and pegfilgrastim-treated groups, and side-effects of chemotherapy and cost-effectiveness of pegfilgrastim were examined. RESULTS: Eighty-six cycles of DCF therapy were conducted (33 and 53 cycles, respectively). FN was observed in 20 (60.6%) and seven (13.2%) cases, respectively (p<0.001). The lowest absolute neutrophil count during chemotherapy was significantly lower in the non-pegfilgrastim group (p<0.001), and the number of days until improvement from nadir was significantly shorter in the pegfilgrastim group (9 vs. 11 days; p<0.001). No significant difference was found in the onset of grade 2 or more adverse events by Common Terminology Criteria for Adverse Events. However, renal dysfunction was significantly lower in the pegfilgrastim group (30.7% vs. 60.6%, p=0.038). Hospitalization costs were also significantly lower in this group (692,839 vs. 879,431 Japanese yen, p=0.028). CONCLUSION: This study revealed the usefulness and cost-effectiveness of pegfilgrastim in prevention of FN in patients treated with DCF.

Successful treatment of advanced gastric cancer with liver metastasis by S-1 + CDDP and S-1 therapy without surgery.

It is generally reported that prognosis of patients who have unresectable gastric cancer is from 3 to 5 months with best supportive care. Despite the improvement of survival after the appearance of S-1, the outcome of treatment for advanced gastric cancer is still unfavorable. Here we present a valuable case of advanced gastric cancer with synchronous liver metastasis, which was treated by S-1 + CDDP and S-1 therapy without surgery. A 58-year-old man was referred to our hospital with a diagnosis of advanced gastric cancer with liver metastasis at stage of cT3N0M1. He underwent first-line chemotherapy consisting of S-1 plus cispatin. 3 months later, a follow-up endoscopy revealed complete response (CR) of the gastric lesion. 3 months later, computed tomography (CT) also demonstrated disappearance of liver metastasis. Then he underwent maintenance chemotherapy with S-1 alone for 8 months. To date, there has been no recurrence for 6 years and 6 months since the acquisition of CR.

Durable Flap-Valve Mitigation of Duodenogastric Reflux, Remnant Gastritis and Dumping Syndrome Following Billroth I Reconstruction.

BACKGROUND: We have reported the short-term results of pylorus reconstruction gastrectomy (PRG) that prevents duodenogastric reflux (DGR) and remnant gastritis after distal gastrectomy. We herein report the long-term results of the PRG. PATIENTS AND METHODS: PRG was performed in 37 patients (age 31 to 86 [mean 67.8 ± 12.3] years, male:female = 22:15) with gastric cancer from June 2006 through December 2013. We examined the long-term outcome in 28 patients (age 41 to 86 [mean 67.0 ± 10.7] years, male:female = 18:10) that passed over 3 years after surgery (LTR 44.1 ± 11.7 months), and compared with their short-term result after the operation (STR 13.1 ± 6.9 months). The adverse events of gastric surgery evaluated in this study consisted of the degree of remnant gastritis, the presence of dumping syndrome, and degree of weight loss (%). RESULTS: There was no difference in the degree of DGR and remnant gastritis by gastroscopic finding between LTR and STR after PRG (P = 0.21). Statistically, there was no difference in the bile acid concentration of remnant gastric juice between LTR and STR (108.4 ± 254.1 vs. 94.0 ± 208.6 µmol/L, P = 0.33), and weight loss of LTR was the same as that of STR (5.67 ± 7.08 vs. 4.59 ± 5.63%, P = 0.34). There were few morphological changes in the reconstructed pylorus by the long-term course, but 2 patients showed mild atrophy. CONCLUSION: The form of reconstructed pylorus and the effect that reduces side effects of Billroth I seem to last for a long time.

Laparoscopic repair for intraoperative injury of the right hepatic artery during cholecystectomy.

Right hepatic artery (RHA) injury is a complication that occurs during laparoscopic cholecystectomy, which can sometimes cause hepatic artery pseudoaneurysm or ischemic hepatic necrosis. Therefore, RHA should be managed carefully. Herein, we report a case of intraoperative RHA injury that was successfully repaired during laparoscopic cholecystectomy. Bleeding was controlled prior to the cholecystectomy with vascular clamp forceps that had been inserted through an additional trocar, and repair of the RHA injury was then performed laparoscopically. The postoperative course was uneventful, and patency of the RHA and its sectional arteries were confirmed by CT arteriography. Laparoscopic repair of minor RHA injuries can be managed safely if bleeding is adequately controlled.

Effects of half-solid nutrients on gastroesophageal reflux in beagle dogs with or without cardioplasty and intrathoracic cardiopexy.

BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) has become an important modality to provide enteral access for long-term nutritional support. Nevertheless, aspiration of liquid nutrients due to vomiting and reflux esophagitis caused by gastroesophageal reflux (GER) is a significant problem associated with tube feeding by PEG. MATERIALS AND METHODS: First, gastrostomy as an access for enteral nutrition and esophagostomy for gastroesophageal pH and Bilitec monitoring were performed in eight beagle dogs, in which the influence of viscosity of an enteral formula on the degree of GER was investigated using a commercially available liquid meal and a nearly isocaloric half-solid diet that was prepared by adding a solution mixed with dextrin, pectin, and calcium lactate. Second, similar studies were accomplished in seven beagle dogs that underwent cardioplasty and intrathoracic cardiopexy (a model of GER disease [GERD]). RESULTS: There was no difference in the degree of GER evaluated by Bilitec monitoring between liquid and half-solid nutrients in eight normal dogs, whereas solidifying nutrients significantly reduced the frequency of reflux during the feeding periods (P=0.0180) and post-feeding periods (P=0.0277) in a model of GERD. CONCLUSION: The use of half-solid nutrients for enteral feeding reduced the frequency of reflux in a dog model of GERD.

Protruding masticatory (superfast) myosin heads from staggered thick filaments of dog jaw muscle revealed by X-ray diffraction.

To characterize the structure of jaw muscle fibres expressing masticatory (superfast) myosin, X-ray diffraction patterns of glycerinated fibres of dog masseter were compared with those of dog tibialis anterior in the relaxed state. Meridional reflections of masseter fibres were laterally broad, indicating that myosin filaments are staggered along the filament axis. Compared with tibialis anterior fibres, the peak of the first myosin layer line of masseter fibres was lower in intensity and shifted towards the meridian, while lattice spacings were larger at a similar sarcomere length. These suggest that the myosin heads of masticatory fibres are mobile, and tend to protrude from the filament shaft towards actin filaments. Lowering temperature or treating with N-phenylmaleimide shifted the peak of the first myosin layer line of tibialis anterior fibres towards the meridian and the resulting profile resembled that of masseter fibres. This suggests that the protruding mobile heads in the non-treated masticatory fibres are in the ATP-bound state. The increased population of weakly binding cross-bridges may contribute towards the high specific force of masticatory fibres during contraction. Electron micrographs confirmed the staggered alignment of thick filaments along the filament axis within sarcomeres of masticatory fibres, a feature that may confer efficient force development over a wide range of the sarcomere lengths.

Early postoperative enteral nutrition is useful for recovering gastrointestinal motility and maintaining the nutritional status.

PURPOSE: The efficacy of enteral nutrition in postoperative nutritional management is known, but the effects on gastrointestinal motility and nutrition have not yet been elucidated. The purpose of this study was to compare the effects of enteral and parenteral nutrition soon after open abdominal surgery on gastrointestinal motility and nutritional status. METHODS: A partial resection of rectum models was prepared to compare two types of nutrient administration: enteral nutrition and total parenteral nutrition. The differences between the effects of nutrition types in terms of gastrointestinal motility and nutritional status were investigated. RESULTS: Enteral nutrition contributed to recovery of gastrointestinal motility and maintenance of nutritional status. CONCLUSION: Enteral nutrition should therefore be initiated soon after surgery if the gastrointestinal tract is available.

Effect of gelatinization on gastric emptying and absorption.

BACKGROUND/AIMS: For gastrointestinal functional analysis such as gastric emptying tests, either a liquid or solid meal is used as a test meal. Only a few studies have compared meal characteristics, such as liquid and solid. No previous study has compared test meals that had the same composition but different properties. The aim of this study was to compare the gastric emptying and absorption obtained by 13C-breath test after ingestion of liquid or gelatinized liquid nutrients. METHODOLOGY: Ten healthy volunteers were studied four times, with 2-week intervals. For the test meal, 200 mL of liquid meals (200 kcal) and gelatinized liquid meals were used. Gelatinized liquid nutrients were prepared by mixing 6 g, 12 g and 18 g of Natural psyllium husk with 200 mL of liquid meals. Breath samples were collected for four hours. Gastric emptying were expressed as the time of peak excretion, absorption were expressed as the area under the 13CO2 curve up to the time of peak excretion. RESULTS: Gastric emptying times were 54.5, 54.5, 81.7 and 93.3 min. Absorption was 20.8, 20.9, 27.8 and 29.8% dose. CONCLUSIONS: Gelatinization influences gastric emptying, but does not influence absorption. Gelatinized liquid meals may be useful for a substitute for solid meals on gastrointestinal functional analysis.

Epidural analgesia and gastrointestinal motility after open abdominal surgery--a review.

After major abdominal surgery, postoperative ileus is inevitable, and it has always been a challenge for the surgical team to shorten the duration of this period. Based on many clinical and basic reports that affirm the effect on the recovery of gastrointestinal motility, epidural analgesia has been used widely to promote recovery from postoperative ileus. Different techniques have been used to measure gastrointestinal motility in laboratory and clinical investigations. Many of the techniques used in clinical investigations of gastrointestinal motility are controversial because they are subjective. In the laboratory strain gauge force transducer (SGT) can provide objective data on gastrointestinal motility. Nevertheless the significance of SGT in the clinical setting is yet to be confirmed. Therefore in this review we examine both clinical and laboratory outcomes of epidural analgesia on gastrointestinal motility to present the possibility for the development of gastrointestinal motility research with SGTs. We suggest that further investigation using SGTs may lead to the development of objective methods that allow objective assessment of post-surgical gastrointestinal function.

Epidural administration of morphine facilitates time of appearance of first gastric interdigestive migrating complex in dogs with paralytic ileus after open abdominal surgery.

Morphine is known to delay gastric emptying and intestinal transit, although epidural morphine is believed to decrease postoperative complications. However, these findings are still controversial and based only on clinical observations. We investigated the effects of epidural morphine administration on gut motility by measuring interdigestive migrating complex after open surgery in dogs. Twenty-eight beagles were divided into four groups (n = 7 each) to receive epidural saline (control group), epidural morphine, epidural ropivacaine, or low-dose continuous intravenous morphine. Strain gauge force transducers were sutured under open operation to the serosal surface of the stomach, duodenum, jejunum, and ileum to monitor gut motility. Time of appearance of first interdigestive migrating complex from the stomach propagated to the distal intestine was significantly shorter in the group that received epidural morphine compared with the other three groups. These results suggest that epidural administration of morphine may facilitate recovery from paralytic ileus after open abdominal surgery, perhaps through its effects on the central nervous system.

Effect of Dai-kenchu-to on gastrointestinal motility based on differences in the site and timing of administration.

The purpose of this study was to investigate the effects of the herbal medicine dai-kenchu-to on gastrointestinal motility based on differences in the administration site and timing. We sutured strain-gauge transducers to the stomach (three), duodenum (one), jejunum (one), ileum (one), and colon (two) and inserted indwelling tubes into the stomach, jejunum, and proximal colon of beagles. Dai-kenchu-to was administered to each site during the fasting or fed state. During the fasting state, the prokinetic effects of dai-kenchu-to were evident at all administration sites. The effects were attenuated during the fed state. With intracolonic administration, a contraction similar to the giant migrating contraction-like contraction was induced during the fasting and the fed state, and defecation occurred. Despite the differences in administration site and timing, no contraction complex appeared orad to the administration sites. These results indicate that the prokinetic effects of dai-kenchu-to differ with the site or timing of administration.

Usefulness of automatic triangular anastomosis for esophageal cancer surgery using a linear stapler (TA-30).

In a clinical evaluation, thirty-one patients with thoracic esophageal cancer who were treated from 1997 to 2000 were selected as subjects including those who underwent hand sewn anastomosis method, circular stapler method and triangular anastomosis method. Incidence of anastomosis failure was 27.3%, 25.0% and 8.3% for the hand sewn anastomosis method, circular stapler method and triangular anastomosis method, respectively. Anastomosis stenosis was found in 32.4%, 45.6% and 8.3% for the hand sewn anastomosis method, circular stapler method and triangular anastomosis method, respectively. In the basic examination, reduction rate of anastomosis caliber was 22.1+/-4.8%, 14.9+/-1.4% and 7.37+/-0.9%, for the hand sewn anastomosis method, circular stapler method and triangular anastomosis method. Microscopic evaluation revealed serious problems with the circular stapler method. The cause of anastomotic stenosis may include the fact that if anastomosis is performed by a circular stapler method, all the layers of gastrointestinal tract are punched out at the anastomosis portion, and mucosal conjugation is not observed and the muscular layer is exposed in the inner lumen of the gastrointestinal tract. Taking that the ulcer is formed circularly at the anastomotic portion into account, it is easily understood that this circular ulcer develops into stenosis in the healing process. The advantage of triangular anastomosis for esophago-gastric anastomosis is less suture failure, and is extremely advantageous for prevention of stenosis at the anastomotic portion when compared with other anastomosis methods. However, with regard to the healing process of eversion anastomosis in gastrointestinal tract instrumental anastomosis, detailed examination is expected hereafter.