RESUMEN

BACKGROUND: The geriatric nutritional risk index (GNRI) is reportedly a useful factor for predicting postoperative complications in elderly patients with several cancers. The aim of this study was to investigate the relationship between postoperative complications and the GNRI in elderly patients with renal cell carcinoma (RCC). MATERIALS AND METHODS: The clinical data of 62 patients who were ≥65 years old and underwent open surgery for RCC were analyzed retrospectively. The American Society of Anesthesiologists physical status, Charlson comorbidity index, surgical procedure, body mass index, GNRI, platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR), psoas muscle index (PMI), visceral fat area, and subcutaneous fat area were examined. The association of the GNRI and immunonutritional parameters with postoperative complications was analyzed by the univariate and multivariate analyses. RESULTS: Grade ≥ II postoperative complications evaluated by the Clavien-Dindo classification were seen in 11 out of 62 cases. In the Spearman's correlation test, the GNRI showed a significant negative correlation with the PLR and NLR and a significant positive correlation with the PMI. The group with postoperative complications showed a significantly lower GNRI, higher PLR, and higher NLR than those without complications. In the multivariate analysis, a GNRI ≤92 was independently associated with postoperative complications. CONCLUSION: The GNRI might play an important role in evaluation of the risk of postoperative complications in open surgery for elderly RCC patients.

Asunto(s)

RESUMEN

Cancer patients often suffer from severe pain related to bone metastasis. We encountered a patient in whom the addition of topical non-steroidal anti-inflammatory drugs (NSAIDs) for persistent pain related to bone metastasis during therapy with opioids and oral NSAIDs reduced pain, improving activities of daily living (ADL). Fentanyl patches, celecoxib, denosumab, and topical NSAIDs (loxoprofen tape, felbinac) were administered to a 72-year-old patient with gastric cancer and pain related to bone metastasis. Pain control was favorable, with a numerical rating scale (NRS) score of 2 and Japanese version Support Team Assessment Schedule (STAS-J) score of 1. Intervention by pharmacists for the use of topical NSAIDs decreased both the NRS and STAS-J scores to zero, improving ADL. The results suggest that topical NSAIDs relieve bone-metastasis-related pain, improving ADL. When bone-metastasis-related pain is localized, the prescription of topical NSAIDs should be considered, and positive intervention by pharmacists regarding their usage should be promoted.

Asunto(s)

RESUMEN

The influence of androgen deprivation therapy (ADT) for prostate cancer on the hip geometric properties evaluated by dual-energy X-ray absorptiometry (DXA) has not yet been demonstrated. This study aimed to investigate the changes in these properties after 1 year of ADT. A total of 65 Japanese men with prostate cancer who underwent ADT for the first time in our facility were included in the study. The hip geometric parameters and the bone mineral density (BMD) taken before and after 1 year of ADT were retrospectively examined. With ADT, we not only confirmed significant BMD annual changes in the lumbar spine, the femoral neck, and the total hip of -1.65%, -1.91%, and -2.20%, respectively, but we also confirmed significant annual changes in cross-sectional areas, cross-sectional moments of inertia, and section modulus in the narrow femoral neck of -2.55%, -3.50%, and -3.14%, respectively. The annual rate of decrease in the femoral neck BMD was significantly higher in patients with visceral fat obesity than in those without visceral obesity (-1.79% vs. -0.28%). One year of ADT for Japanese men with prostate cancer might decrease the strength of bending and the structural rigidity as well as BMD at the femoral neck.

Asunto(s)

RESUMEN

This study investigated what sort of effects would occur in terms of sexual function in Japanese patients with benign prostatic hyperplasia (BPH), upon switching from combination therapy with an α1 blocker (AB) and dutasteride (DUT) to combination therapy with tadalafil (TAD) and DUT. The baseline and the 15-item International Index of Erectile Function (IIEF-15), Erection Hardness Score (EHS), International Prostate Symptom Score (IPSS), and Overactive Bladder Symptom Score (OABSS) 3 months after switching to the daily administration of TAD 5 mg/DUT 0.5 mg combination therapy, along with the age, prostatic volume, body mass index (BMI), and past medical history of 49 patients who were treated with AB/DUT as pretreatment, were retrospectively investigated. TAD/DUT combination therapy significantly improved the total score of IIEF-15 (from 17.8 ± 11.6 to 21.4 ± 13.9, p = .0047), erectile function domain (from 5.8 ± 5.8 to 7.6 ± 7.1, p = .0186), and EHS (from 1.9 ± 1.3 to 2.6 ± 1.2, p < .0001). Although IPSS and QOL index were significantly improved, no significant differences were observed for OABSS. Switching from AB/DUT combination therapy to TAD/DUT combination therapy brought about improvement in erectile function while leaving room to improve urinary status in Japanese patients.

Asunto(s)

RESUMEN

Penile strangulation is a disease which causes circulatory failure in the distal part of the penis by the penis strangulated by foreign substances, and it is a rare emergency disease in urology. Most of the motives are for pranks, sexual intercourses and treatments of incontinence. We herein report the clinical course of penile strangulation complicated by penile cancer. Although the treatment was completed in accordance with its clinical stage of the penile cancer without any perioperative complications, it was considered that more case studies and further examinations would be needed to determine the treatment plans.

RESUMEN

There are currently several options for tyrosine kinase inhibitor as a systemic therapy for metastatic renal cell carcinoma (mRCC). The successful control of adverse events caused by such drugs, along with eliciting long-term maximum effect, are the major issues with respect to the treatment strategy for mRCC. We herein report the clinical course of mRCC, in which erythema multiforme major was observed on the 13th day of the first course of sunitinib, but the symptoms improved after the immediate withdrawal of sunitinib, as well as the administration of topical steroids and oral antihistamines alone.

RESUMEN

Background: The prognosis of non-shockable out-of-hospital cardiac arrest is worse than that of shockable out-of-hospital cardiac arrest. We investigated the associations between the etiology and prognosis of non-shockable out-of-hospital cardiac arrest patients who experienced the return of spontaneous circulation after arriving at hospital. Methods and Results: All subjects were extracted from the SOS-KANTO 2012 study population. The subjects were 3,031 adults: (i) who had suffered out-of-hospital cardiac arrest, (ii) for whom there were no pre-hospital data on ventricular fibrillation/pulseless ventricular tachycardia until arrival at hospital, (iii) who experienced the return of spontaneous circulation after arriving at hospital. We compared the patients' prognosis after 1 and 3 months between various etiological and presumed cardiac factors. The proportion of the favorable brain function patients that developed pulmonary embolism or incidental hypothermia was significantly higher than that of the patients with presumed cardiac factors (1 month, P < 0.0001 and P < 0.0001, respectively; 3 months, P = 0.0018 and P < 0.0001, respectively). In multiple logistic regression analysis, pulmonary embolism and incidental hypothermia were found to be significant independent prognostic factors for 1- and 3-month survival and the favorable brain function rate. Conclusions: In patients who suffer non-shockable out-of-hospital cardiac arrest, but who experience the return of spontaneous circulation after arriving at hospital, the investigation and treatment of pulmonary embolism as a potential etiology may be important for improving post-resuscitation prognosis.

RESUMEN

Summary We assessed the accuracy of telephone triage at the 7119 telephone consultation centre in Tokyo. We evaluated walk-in patients at primary care facilities in a clinic or hospital. Nurses asked all patients calling 7119 to join the study and gave them a specific identification number (ID no) at the end of the telephone consultation. The outcome of the consultation was defined as discharge to home (home), admittance to hospital (hospitalization), referral, or transfer to another hospital. After matching consultation records and patient data by ID no, emergency medical physicians reviewed the protocol for problems. During the study, consultation nurses issued an ID no in 17,141 cases, and hospitals and clinics sent back the data on 1205 patients. Among these patients, 1119 cases (93%) were home, 59 cases (5%) were hospitalization, 18 cases (2%) were referral and 9 cases (1%) were transfer. Of the 86 cases which had an outcome of hospitalization, referral or transfer, there were 56 cases with matched patient data. Among these 56 cases, review showed no significant problems with 37 cases. However, there were 11 cases with patient refusal to comply with the triage recommendation, 4 cases with 7119 staff education problems and 4 cases with problems with the protocol itself. We were able to evaluate the 7119 telephone triage system in Tokyo. The study identified three types of problems with the triage process: refusal of telephone triage recommendations, problems with staff education and problems with the protocol itself.

RESUMEN

A 61-year-old man who had undergone left pneumonectomy 7 years before for lung cancer was scheduled for thoracoscopic partial pulmonary resection of the right lung because of pneumothorax. Anesthesia was induced with propofol and maintained with sevoflurane and thoracic epidural block. He was monitored with electrocardiogram, direct arterial pressure, pulse oximetry and capnogram. Arterial blood gas sampling was done as required. During the operation, ventilation was maintained with mechanical and intermittent manual ventilation. Hemodynamic status was stable and intra- and post-operative course was uneventful. PCPS, ECLS, CVC and PAC were not required. A successful and satisfactory anesthetic management was accomplished by good cooperation between anesthesiologists and surgeons.

Asunto(s)

RESUMEN

Determine the effectiveness of decontamination, and perform thorough dry or wet decontamination, depending on the circumstances. Always remain cognizant of the fact that, even after decontamination has been completed, contamination may not have been completely eliminated. Perform periodic monitoring to determine whether secondary exposure has occurred in health care workers; if it appears that secondary exposure has occurred, then the PPE level must be increased and attempts must be made to identify and eliminate the source of the contamination. Finally, if the victims were exposed through ingestion, then consider the possibility that secondary exposure will occur during gastric lavage.

Asunto(s)

Asunto(s)

RESUMEN

The Tokyo subway sarin attack was the second documented incident of nerve gas poisoning in Japan. The St. Luke's International Hospital received 640 patients on the day of the attack. Reduction in plasma cholinesterase (ChE) activity was generally associated with the severity of acute signs of toxicity. With time and treatment, the value rose quickly. To evaluate possible residual signs of symptoms 1 year after the attack, we sent questionnaires to the victims; of 303 respondents, 45% still had some symptoms including eye problems, easy fatigability, headache, and fear. Therefore, we conducted a study in collaboration with investigators at the Tokyo University Department of Public Health to evaluate possible long-term neuropsychological sequelae. The findings suggest the need to closely follow such patients for possible persistent functional changes.

RESUMEN

A 62-year-old man complicated with old antero-septal wall myocardial infarction and atrial fibrillation suffered from lung and pancreas cancer. He underwent gastro-duodenum bypass surgery under epidural combined with general anesthesia. His ECG and echocardiogram revealed atrial fibrillation and his left ventricular ejection fraction was 35%. After the start of surgery under general anesthesia, EHR was stable between 80-100 beats x min(-1) but rapid atrial fibrillation developed with a rate of over 140 beats x min(-1) after epidural injection of 0.375% ropivacaine 3 ml. Treatment including continuous intravenous diltiazem and several bolus intravenous injections of verapamil failed to decrease the heart rate. Therefore we used landiolol, a short-acting beta blocker, to control heart rate. HR decreased without decreasing his blood pressure. Continuous landiolol infusion was maintained for 3 hours and 30 minutes in the ICU. After finishing infusion, his heart rhythm never became rapid atrial fibrillation. We conclude that landiolol is useful for heart rate control of rapid atrial fibrillation.

Asunto(s)

RESUMEN

BACKGROUND: Laparoscopic procedures are considered relatively low-invasive. However, there exists a small but important risk of developing complications related to carbon dioxide (CO2) insufflation. End-tidal CO2 (PetCO2) monitoring may not be a sufficient guide to adjust pulmonary ventilation during laparoscopic surgery, and arterial CO2 (PaCO2) monitoring is not always indicated. We evaluated the accuracy and feasibility of transcutaneous CO2 (PtcCO2) monitoring during laparoscopic surgery. METHODS: Thirty adult patients undergoing abdominal or gynecological laparoscopic surgery were studied. PtcCO2, PaCO2 and PetCO2 were measured before laparoscopy, and 30 and 60 minutes after beginning of CO2 insufflation. PtcCO2 and PaCO2 were also measured in the recovery room under spontaneous respiration. RESULTS: During operation, the PtcCO2 values demonstrated a high degree of correlation with PaCO2 (r = 0.92), and PetCO2 values also demonstrated generally a good correlation with PaCO2 (r = 0.85). The PtcCO2 PaCO2 gradient was -0.6 +/- 2.2 mmHg, while the PetCO2-PaCO2 gradient was -3.9 +/- 2.7 mmHg. In the recovery room, PtcCO2 values still demonstrated a high correlation with PaCO2 (r = 0.91). CONCLUSIONS: The transcutaneous devices provide an effective method for non-invasive monitoring of PCO2 in situations where continuous monitoring of CO2 levels is desired such as peri-operative period of laparoscopic surgery.

Asunto(s)

RESUMEN

BACKGROUND: High frequency jet ventilation (HFJV) via thin tracheal tube is a convenient method of ventilation in microlaryngosurgery, but the problem of the assessment of oxygen and carbon dioxide status during HFJV is yet to be studied. METHODS: Fifteen patients undergoing microlaryngosurgery under total intravenous anesthesia with HFJV were studied. The combined transcutaneous carbon dioxide (PtcCO2) and oxygen (PtcO2) levels were compared with arterial blood gas values (PaCO2, PaO2). RESULTS: The PtcCO2 values demonstrated a high degree of correlation with PaCO2 before intubation (r = 0.97), during HFJV (r = 0.96), and after anesthesia (r = 0.93). The PaO2 values demonstrated a generally good correlation with PaO2 before intubation (r = 0.78) and during HFJV (r = 0.83), but not after anesthesia (r = 0.54). CONCLUSION: Capnography values are invalid during HFJV, and an arterial catheter is not always indicated and feasible in microlaryngoscopy. The transcutaneous devices provide an effective method for non-invasive monitoring of PaCO2 in situations where continuous and precise control of CO2 levels is desired such as in perioperative period of microlaryngosurgery with HFJV.

Asunto(s)