[Efficacy of tegafur/uracil plus oral leucovorin therapy for advanced or recurrent colorectal cancer].

The aim of this study was to evaluate the efficacy of tegafur/uracil (UFT) and oral Leucovorin(UZEL) in patients with advanced or recurrent colorectal cancer. Eight patients were treated with UFT/UZEL therapy as a first-line chemotherapy. UFT(300 mg/m(2)/day) and UZEL (75 mg/body/day) were administered orally for 28 consecutive days followed by a 7-day rest period, and this schedule was repeated every 5 weeks. The mean of treatment courses given to the patients was 7.6. Tumor response was evaluated in 7 patients who had assessable lesions, and the response rate was 86% (6 PR and 1 NC). Adverse reactions of grade 3 were observed in 2 patients (25%), but toxicity did not cause a discontinuance of treatment in any case. The UFT/UZEL therapy was considered to be a promising regimen for advanced or recurrent colorectal cancer from a standpoint of effect, safety and QOL of patients.

Long-term outcome of S-1 and cisplatin combination therapy in patients with advanced or recurrent gastric cancer.

BACKGROUND: Although combination therapy of S-1 and cisplatin (CDDP) has excellent efficacy against gastric cancer, the effect of the treatment on survival has been unclear. The aim of this study was to evaluate the long-term outcome of this combination therapy. METHODS: Sixty-three patients with advanced or recurrent gastric cancer were treated with S-1, with or without CDDP, as first-line chemotherapy, and the clinical results were compared retrospectively. S-1 was administered orally at a standard dose of 80 mg/m(2). In the treatment of the S-1 group, S-1 was given for 28 consecutive days, followed by a 14-day rest. In the treatment of the S-1/CDDP group, S-1 was given for 21 consecutive days, followed by a 14-day rest, and CDDP, at 60 mg/m(2), was infused on day 8. RESULTS: The incidence of adverse reactions of more than grade 3 was 22.5% in the S-1 group and 43.5% in the S-1/CDDP group, and the treatment compliance was better in the S-1 group. The overall response rate was 25.9% in the S-1 group, and 36.8% in the S-1/CDDP group. The combination of S-1 with CDDP had better effects on the primary lesion and on differentiated-type carcinoma than S-1 alone. However, there was no difference in survival between the two patient groups. The median survival time after the initiation of treatment in the S-1 group was 322 days, and that in the S-1/CDDP group was 319 days. CONCLUSIONS: Our results suggest that the combination of CDDP with S-1 does not improve the long-term outcome of S-1 therapy.

Propranolol alone may not be acceptable to prevent first esophageal variceal bleeding in Japanese cirrhotic patients: randomized controlled trial.

BACKGROUND AND AIM: In Japan, endoscopic injection sclerotherapy (EIS) is widely used to prevent first esophageal variceal bleeding, in contrast to pharmacological therapy which is the main treatment used in the rest of the world. The present study investigated if propranolol alone is acceptable to prevent first esophageal variceal bleeding in Japanese cirrhotic patients. This was compared with EIS. METHODS: Twenty-five Japanese cirrhotic patients with endoscopically proven, likely to bleed esophageal varices were randomly assigned for propranolol administration (12 patients; group A) and EIS (13 patients; group B) to prevent first esophageal variceal bleeding. Complications, non-recurrence rate, bleeding rate and probability of survival were compared between the two groups. RESULTS: One patient in group A had severe bradycardia with loss of consciousness that seriously worsened his quality of life. The cumulative non-recurrence rate of group A was significantly lower compared with that of group B (P < 0.05). In group A, 2 of the 12 patients requested to discontinue taking propranolol and were excluded from the trial. The EIS treatment (group B) showed excellent results. No patient in group A or group B bled from esophageal varices throughout this study. The two groups showed no statistically significant differences in probability of survival. CONCLUSIONS: Propranolol alone may not be acceptable to prevent first esophageal variceal bleeding in Japanese cirrhotic patients.

Pulmonary embolism following laparoscopic surgery: a report of two cases.

Laparoscopic abdominal surgery is considered a low-risk procedure for postoperative complications because of reduced surgical stress and earlier mobilization. We report two patients who experienced pulmonary embolism following laparoscopic surgery; one patient underwent umbilical hernia repair and the other cholecystectomy. Although pulmonary embolism is indeed rare after laparoscopic surgery, early detection and early treatment are determinative factors for a good prognosis. Therefore, medical caregivers must remember that pulmonary embolism can be a critical complication after laparoscopic surgery and preventive measures should be employed for high-risk subjects.

Laparoscopic splenectomy for portal hypertension.

BACKGROUND/AIMS: Laparoscopic splenectomy is now increasingly being performed. However, controversy remains regarding the effectiveness of a laparoscopic splenectomy for patients with portal hypertension. METHODOLOGY: Seventy-three patients with portal hypertension who underwent a laparoscopic splenectomy from February 1992 until October 2000 were reviewed and the effectiveness of the procedures for portal hypertension was evaluated. Forty-two patients had esophagogastric varices and twenty had a concomitant hepatocellular carcinoma. The indications for surgery were bleeding tendency due to thrombocytopenia (n = 40), difficulty in receiving treatment for hepatocellular carcinoma due to thrombocytopenia (n = 18), and sclerotherapy-resistant esophagogastric varices (n = 15). RESULTS: A laparoscopic splenectomy was successfully performed in all the patients. The rate of conversion to conventional open surgery was 9.6% (7/73). The mean operative time was 210.1 +/- 101.9 minutes, and the estimated blood loss was 374.7 +/- 352.4 mL. There were no cases of mortality, and morbidity was encountered in 11.0% of patients. The increase in the platelet count correlated significantly to the spleen weight (P < 0.001). The platelet count had been maintained at over 10 x 10(4)/mm3 for over three years. Eighteen patients with hepatocellular carcinoma successfully underwent treatment for hepatocellular carcinoma after surgery and no recurrence of esophagogastric varices was encountered. CONCLUSIONS: A laparoscopic splenectomy resulted in the successful secondary treatment of hepatocellular carcinoma and esophagogastric varices. Portal hypertension was not a contraindication. A laparoscopic approach is therefore the procedure of choice for a splenectomy in portal hypertension.

Endoscopic injection sclerotherapy in the management of 2105 patients with esophageal varices.

BACKGROUND: The objective of this study is to examine the overall clinical results of endoscopic injection sclerotherapy (EIS) for patients with esophageal varices in our institution. METHODS: From January 1982 to May 2001, 2105 patients with esophageal varices were treated with EIS, which included prophylactic injections for patients with risky varices according to our criteria. Follow-up endoscopy was performed every 3 months, and recurrent varices were treated with additional EIS. RESULTS: Acute variceal bleeding was controlled in 468 of 473 patients (98.9%). Esophageal varices were completely eradicated in 1757 of 2105 patients (83.5%) with 3.8 +/- 1.6 sessions of EIS. The cumulative recurrence rates were 32.2% at 5 years, 36.5% at 10 years, and 37.8% at 15 years. The cumulative nonbleeding rates were 92.3% at 5 years, 90.1% at 10 years, and 89.5% at 15 years. The survival rate of acute bleeders was significantly lower than for both elective and prophylactic cases (P <.05). The overall cumulative survival rate was 28.2% at 10 years. CONCLUSIONS: EIS is the first choice of treatment for esophageal variceal bleeding, and rebleeding was shown to be well controlled in a long-term follow-up with endoscopy and additional EIS. The lower survival rate observed in acute bleeders may therefore justify the use of prophylactic EIS.

Long-term results of endoscopic Histoacryl injection sclerotherapy for gastric variceal bleeding: a 10-year experience.

BACKGROUND: The long-term efficacy and safety of endoscopic injection of N-butyl-2-cyanoacrylate (Histoacryl) were evaluated as the initial treatment for bleeding gastric varices. PATIENTS AND METHODS: Fifty-two patients with bleeding gastric varices underwent endoscopic injections of Histoacryl for hemostasis over a 10-year period. Histoacryl was injected intravariceally. Among these 52 patients, 32 had active bleeding and 20 had recent bleeding. Most of the varices were large (F2 or F3, 48 cases). After Histoacryl injection, the patients were followed endoscopically with retreatment administered as necessary. The patients were followed for a mean 28.1 months. RESULTS: The rate of initial hemostasis (no bleeding occurred for 48 hours after sclerotherapy) was 96.2%. Cumulative nonbleeding rates were 64.7%, 52.7%, and 48.2% at 1, 5, and 10 years, respectively. When rebleeding occurred, 80.0% was within 1 year after initial injection. Recurrent bleeding was easily stopped with the reinjection of Histoacryl in most patients. The treatment failure-related mortality rate was 4.0% (2 of 52). The cumulative survival rates were 66.9%, 60.4%, and 55.5% at 1, 5, and 10 years, respectively. The mortality depended on either malignancy or liver function (Child-Pugh classification). CONCLUSIONS: These results suggest that Histoacryl injection sclerotherapy is highly effective for the treatment of bleeding gastric varices, with rare complications occurring both acutely and long-term. Therefore, Histoacryl injection sclerotherapy is considered to be the first choice of treatment for bleeding gastric varices, but the rate of recurrent bleeding is so high that further methods or devices still need to be developed in order to prevent gastric variceal rebleeding.

Laparoscopic splenectomy for hematologic diseases.

BACKGROUND: Laparoscopic splenectomy has been demonstrated to be technically feasible and safe for the treatment of hematologic diseases. METHODS: The study comprised 64 consecutive patients with chronic immune thrombocytopenia purpura (ITP) who were admitted to our hospital from 1992 to 2000 and underwent laparoscopic splenectomy. Forty-one consecutive patients with ITP who underwent open splenectomy performed at the same hospital by the same surgical team between 1986 and 2000 were selected as the control group. RESULTS: We performed laparoscopic splenectomies for ITP, hereditary spherocytosis (HS), malignant lymphoma, autoimmune hemolytic anemia, and cryoglobulinemia. Laparoscopic surgery as compared with open surgery in ITP revealed a significantly lower pain medication requirement, an earlier resumption of oral intake, and a shorter hospital stay, but a longer operative time. During the present study (range: 3.8-80 months), the cumulative rate of nonrecurrence was 67.9% at 5 years after surgery, which was similar to the rate for the previous open splenectomy. CONCLUSIONS: Laparoscopic splenectomy is considered to be a suitable alternative therapeutic modality in the treatment of hematologic diseases.