Postoperative Drug Therapy Research Articles

Quality of life during one year of postoperative prophylactic drug therapy after intestinal resection in Crohn’s patients: Results of the APPRECIA trial

BackgroundIn APPRECIA trial, Crohn's disease (CD) patients undergoing intestinal resection were randomized to postoperative adalimumab (ADA) or azathioprine (AZA). AimsTo evaluate health-related quality of life (HRQoL) in APPRECIA trial. MethodsHRQoL was evaluated using disease-specific shortened Spanish version of the IBDQ (SIBDQ-9) and generic European Quality of Life-5 Dimensions (EQ-5D) questionnaires, completed at baseline and at weeks 24 and 52. ResultsSixty-one patients (37 ADA and 24 AZA) had evaluable data for HRQoL. Patients treated with ADA or AZA had significant improvement from baseline to weeks 24 and 52 in SIBDQ-9 and EQ-5D (p < 0.001 and p ≤ 0.006 for all comparisons, respectively). There were no differences between treatment arms in mean change in SIBDQ-9 and EQ-5D at weeks 24 and 52 vs baseline. Only patients without endoscopic recurrence had significant improvement in SIBDQ-9 (p < 0.001) and EQ-5D (p < 0.001) at week 52. At week 52, there was a high to moderate negative correlation between CDAI score with SIBDQ-9 score (Pearson’s r: −0.768) and with EQ-5D index (r: −0.644). ConclusionHRQoL improved after intestinal resection in CD, irrespective of the postoperative therapy used (ADA or AZA). Outcomes in HRQoL were associated with prevention of endoscopic recurrence, since improvements in HRQoL were only significant in patients with endoscopic remission at 1 year.

SY27-4 - Current standard and future perspectives in the post-operative treatment of triple negative breast cancer

Chemotherapy is the current standard of care as a postoperative drug therapy for triple negative breast cancer, and it is indicated with tumor diameter of 0.5 cm or more or positivity to lymph node metastasis. Basically, anthracycline and taxane are necessary, but TC chemotherapy, which is a non-anthracycline regimen in some early stage cancers, may be a treatment option. Dose dense chemotherapy which reduces treatment intervals by every 2 weeks by using G-CSF for high risk patients with recurrence is effective and recommended. There is no evidence of platinum as adjuvant chemotherapy. Concomitant use of bevacizumab for molecular targeted drugs could not demonstrate effectiveness. Currently several studies with immunity checkpoint inhibitors are ongoing and results are awaited. From the results of the CREATE-X, postoperative addition of capecitabine to non-pCR cases after preoperative chemotherapy was effective particularly in triple negative breast cancer. As a future treatment prospect, enrichment strategy is expected to extract postoperative adjuvant therapy by extracting cases with high recurrence risk by preoperative chemotherapy. At present, administration of platinum (EA 1131) or immune checkpoint inhibitor pembrolizumab (SWOG 1418) after surgery are carried out. There are also treatment strategies according to the specific type in triple negative breast cancer, postoperative PARP inhibitor olaparib (Olympia A) for BRCA mutation positive breast cancer or enzalutamide for androgen receptor positive breast cancer.

Effect of operating room care combined with home care for the postoperative rehabilitation and prognosis of gastric cancer patients with low PTEN gene expression.

The aim of the present study was to analyze the effect of operating room (OR) care combined with home care on postoperative rehabilitation and prognosis of gastric cancer patients with low PTEN gene expression. Ninety-six gastric cancer patients with low PTEN gene expression, who underwent surgical treatment in our hospital were recruited. PTEN expression was measured by semi-quantitative polymerase chain reaction. Participants were randomized into the observation and control groups, with 48 cases each. Participants in the two groups received the same preoperative examination, gastric cancer surgery, postoperative drug therapy, and general care, while observation group participants were provided more comprehensive OR care combined with home care. After 1 year of home care, the self-rating anxiety scale (SAS) and Hamilton anxiety scale (HAMA) scores, rehabilitation status, overall quality of life, and Family Adaptability and Cohesion Scale were applied to compare postoperative rehabilitation and prognosis status in both groups. Data were statistically analyzed. Patients were followed up for 3 years, and survival time was analyzed. The operative time and bleeding volume between the two groups were not significantly different (p>0.05). The time of extubation and postoperative recovery time in the observation group were shorter than in the control group (p<0.01). The postoperative SAS and HAMA scores in both groups were significantly decreased compared with those preoperatively (p<0.01). Additionally, these scores were significantly lower in the observation than in the control group (p<0.01). The rehabilitation status of body function in the observation group was better than in the control group (p<0.01). Regarding the overall quality of life score and family adaptability and cohesion score, the observation group was better than the control group (p<0.01). In conclusion, OR care combined with home care was effective for the care of gastric cancer patients with low PTEN expression. Improving patient mood and mental state played a positive role in postoperative rehabilitation and prognosis.

白内障合并糖尿病非增殖性视网膜病变患者术前局部使用双氯芬酸钠降低眼内IL-12浓度

目的：探讨白内障合并糖尿病非增殖性视网膜病变患者行白内障摘除手术前，局部使用双氯芬酸钠是否降低房水中IL-12浓度。方法：选取在我院拟接受手术治疗的38例白内障合并糖尿病非增殖性视网膜病变患者，随机分配为双氯芬酸钠观察组组和安慰剂对照组，对比分析两组研究对象房水中IL-12水平。其中双氯芬酸钠组17名，安慰剂组21名。双氯芬酸钠组患者在行白内障手术前10天，局部使用0.1%双氯芬酸钠4/日，术后继续用药30天。安慰剂组患者术前局部使用安慰剂10天，4/日，术后规范使用白内障术后用药共30天。所有患者术后均使用抗生素预防感染(妥布霉素滴眼液4/日)，术后用药时间为30天。白内障手术术前收集房水样本用以测量IL-12浓度。结果：双氯芬酸钠组患者房水中IL-12浓度明显低于安慰剂组。结论：IL-12在发生黄斑水肿的糖尿病性白内障患者房水中明显升高。此类患者行超声乳化吸除术后联合植入人工晶体治疗时，于术前应用双氯芬酸钠，术后联合抗生素类药物治疗，可有效减少黄斑水肿的发生，提高术后视力。 Objective: To investigate whether the partial use of diclofenac sodium in the treatment of cataract combined with diabetic non-proliferative retinopathy can reduce IL-12 concentration in the aqueous water. Methods: 38 cases of cataract patients with diabetes mellitus not hyperplastic ret-inopathy to accept the surgical treatment in our hospital, are randomly assigned for diclofenac so-dium observation way and the placebo group, aqueous humor IL-12 levels are compared in re-search object of the two groups. There were 17 in diclofenac sodium and 21 in the placebo group. The patients of diclofenac sodium group were treated with 0.1% diclofenac 4/d and 30 days after surgery for 10 days before cataract surgery. In the placebo group, patients were given a placebo 10 days, 4/d, and postoperative standardized use of cataract surgery for 30 days. All patients were treated with antibiotic prophylaxis (tobramycin eye drops 4/d) after surgery and 30 days after surgery. Water samples collected before the operation of cataract was used to measure IL-12 con-centration. Result: The concentration of IL-12 in the patients with diclofenac sodium was signifi-cantly lower than that in the placebo group. Conclusion: IL-12 was significantly elevated in diabetic patients with diabetic cataract. Such patients when get ultrasonic emulsification therapy gettering postoperative combined implantation of artificial crystal, should apply the preoperative diclofenac sodium, combine postoperative antibiotic drug therapy, which can effectively reduce the occurrence of macular edema, improve visual acuity.

Analysis of relevant factors for recurrence of ovarian endometriosis after conservative laparoscopic surgery

To analyze relevant factors for recurrence of ovarian endometriosis after conservative surgery. A cohort study was performed on 310 patients who had performed conservative surgery for ovarian endometriosis. All patients underwent clinical interview. The relevant factors included: age at surgery, clinical symptom and signs, medical history, gynecologic examination, preoperative gravidity, complication, adenomyosis, American Society for Reproductive Medicine (ASRM) scores, post-operative drug therapy, post-operative gravidity and so on. The logistic regression analysis was performed to determine the predictive factors for recurrence of endometriosis. The relevant factors by univariate analysis were determined. The history of endometriosis surgery, history of intrauterine operation, tenderness nodule at cal-de-sal, bilateral endometrioma, multilocular cyst, intraoperative ASRM scores, complication of adenomyosis and operation time were the risk factors; whereas pre- and post-operative gravidity, post-operative drug therapy, and age at surgery were the protective factors. Meanwhile, the relevant factors by multivariate analysis were also confirmed. The history of endometriosis surgery, history of intrauterine operation, tenderness nodule at cal-de-sal, bilateral endometrioma, multilocular cyst, and intraoperative ASRM scores were the risk factors; whereas post-operative gravidity, post-operative drug therapy, pre-operative gravidity, and age at surgery were the protective factors. The risk factors for recurrence of ovarian endometriosis are history of endometriosis surgery, history of intrauterine operation, tenderness nodule at cal-de-sal, bilateral endometrioma, multilocular cyst, intraoperative ASRM scores, whereas the protective factors are pre- and post-operative gravidity, post-operative drug therapy and age at surgery.

Su1008 Health-Related Quality of Life Improves During One Year of Postoperative Prophylactic Drug Therapy After Ileocecal Intestinal Resection in Crohn's Disease Patients: Results of the APPRECIA Randomized Trial

Su1008 Health-Related Quality of Life Improves During One Year of Postoperative Prophylactic Drug Therapy After Ileocecal Intestinal Resection in Crohn's Disease Patients: Results of the APPRECIA Randomized Trial

P602. Health-related quality of life improves during 1-year of postoperative prophylactic drug therapy after ileocecal intestinal resection in Crohn’s disease patients: results of the APPRECIA randomised trial

P602. Health-related quality of life improves during 1-year of postoperative prophylactic drug therapy after ileocecal intestinal resection in Crohn’s disease patients: results of the APPRECIA randomised trial

Cost-effectiveness of Crohn's disease post-operative care.

To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn's disease following intestinal resection. In the "POCER" study patients undergoing intestinal resection were treated with post-operative drug therapy. Two thirds were randomized to active care (6 mo colonoscopy and drug intensification for endoscopic recurrence) and one third to drug therapy without early endoscopy. Colonoscopy at 18 mo and faecal calprotectin (FC) measurement were used to assess disease recurrence. Administrative data, chart review and patient questionnaires were collected prospectively over 18 mo. Sixty patients (active care n = 43, standard care n = 17) were included from one health service. Median total health care cost was $6440 per patient. Active care cost $4824 more than standard care over 18 mo. Medication accounted for 78% of total cost, of which 90% was for adalimumab. Median health care cost was higher for those with endoscopic recurrence compared to those in remission [$26347 (IQR 25045-27485) vs $2729 (IQR 1182-5215), P < 0.001]. FC to select patients for colonoscopy could reduce cost by $1010 per patient over 18 mo. Active care was associated with 18% decreased endoscopic recurrence, costing $861 for each recurrence prevented. Post-operative management strategies are associated with high cost, primarily medication related. Calprotectin use reduces costs. The long term cost-benefit of these strategies remains to be evaluated.

Effect of intestinal resection on quality of life in Crohn's disease.

Patients with Crohn's disease have poorer health-related quality of life [HRQoL] than healthy individuals, even when in remission. Although HRQoL improves in patients who achieve drug-induced or surgically induced remission, the effects of surgery overall have not been well characterised. In a randomised trial, patients undergoing intestinal resection of all macroscopically diseased bowel were treated with postoperative drug therapy to prevent disease recurrence. All patients were followed prospectively for 18 months. C-reactive protein [CRP], Crohn's Disease Activity Index [CDAI], and faecal calprotectin [FC] were measured preoperatively and at 6, 12, and 18 months. HRQoL was assessed with a general [SF36] and disease-specific [IBDQ] questionnaires at the same time points. A total of 174 patients were included. HRQoL was poor preoperatively but improved significantly [p < 0.001] at 6 months postoperatively. This improvement was sustained at 18 months. Females and smokers had a poorer HRQoL when compared with males and non-smokers, respectively. Persistent endoscopic remission, intensification of drug treatment at 6 months, and anti-tumour necrosis factor therapy were not associated with HRQoL outcomes different from those when these factors were not present. There was a significant inverse correlation between CDAI, [but not endoscopic recurrence, CRP, or FC] on HRQoL. Intestinal resection of all macroscopic Crohn's disease in patients treated with postoperative prophylactic drug therapy is associated with significant and sustained improvement in HRQoL irrespective of type of drug treatment or endoscopic recurrence. HRQoL is lower in female patients and smokers. A higher CDAI, but not direct measures of active disease or type of drug therapy, is associated with a lower HRQoL.

Discussion on the treatment methods of pediatric obstructive sleep apnea hypopnea syndrome

To explore the treatment methods of pediatric obstructive sleep apnea hypopnea syndrome (OSAHS). A total of 386 children with OSAHS were enrolled from June 2008 to April 2011.Ninety children with adenoid and tonsil ≤ degree III (group A) were randomly divided into A1 subgroup and A2 subgroup, while 22 of 296 (group B) children aged less than 3 years old with degree IV adenoid and(or) tonsil were divided into B1 subgroup, and the other 274 of 296 children with degree IV adenoid and (or) tonsil were divided into B1 subgroup, B2 subgroup and B3 subgroup. The adenoid, tonsil size examination and nasal endoscopic examination scores were performed before treatment, 3 months and 6 months after treatment. Drug therapy included oral antibiotics, mometasone furoate as a nasal spray, leukotriene receptor antagonist (LTRAs), mucoactive medications. Conservative treatment meant drug therapy plus negative pressure of sputum aspiration.Surgical treatment meant coblation adenotonsillectomy. A1 subgroup received drug therapy for 3 months; A2 and B1 subgroup received conservative treatment for 3 months; B2 subgroup received coblation adenotonsillectomy after 3 days conservative treatment and postoperative drug therapy for 2 weeks; B3 subgroup received coblation adenotonsillectomy after 2 weeks conservative treatment and postoperative drug therapy for 3 months. The adenoid and tonsil size of A2 subgroup decreased at 3 months after treatment (Wald χ² were 10.584 and 8.366, respectively, P < 0.05), no significant re-increase was found at 6 months, and no decrease was found in the A1 subgroup (P > 0.05). The nasal endoscopic examination scores decreased in both A1 and A2 subgroup at 3 months after the treatment (F = 403.420, P < 0.05), but it was found re-increase in A1 subgroup at the 6 months (P < 0.05), no significant re-increase was found in the A2 subgroup. The polysomnography (PSG) monitor of A2 subgroup was 100.0% normal at 3 months after treatment, while the A1 subgroup was only 43.2% (χ² = 36.189, P < 0.05). B2 and B3 subgroups cured after coblation adenotonsillectomy, but no decrease of the adenoid and tonsil size was found in B1 subgroup (P > 0.05). The nasal endoscopic examination scores of B1, B2 and B3 subgroups showed significant decrease after the treatment, but re-increase was found in both B1 and B2 subgroups at the 6 months (F = 1 614.244, P < 0.05), no significant re-increase was found in the B3 subgroup. The PSG monitor of B3 subgroup was 100.0% normal at 3 months after treatment, B2 subgroup 73.4%, and B1 subgroup only 57.4% (χ² = 90.846, P < 0.05). The treatment method of children with OSAHS should be selected according to the age, condition of disease, and size of the adenoid and tonsil. Adenoid and tonsil ≤ degree III should select conservative treatment; while for degree IV adenoid and (or) tonsil, surgical treatment should be primary choice. Conservative treatment can reduce the risk of perioperative and adequate postoperative drug therapy can help prevent recurrence after surgery.

Long-term follow-up of periarterial sympathectomy for chronic digital ischaemia

This study investigates long-term clinical results (> 10 years) of periarterial sympathectomy in chronic ischaemic digits compared with intermediate-term results (3 years). Periarterial sympathectomy via the palm and volar wrist was carried out on 11 hands of seven patients with digital ischaemia but no gangrene or severe ulceration. The aetiology of ischaemia was Buerger's disease in four hands, collagen disease in three hands, and repetitive digital trauma in four hands. Subjective symptoms were evaluated at a mean follow-up period of 12 years. The efficacy of surgery was assessed objectively using thermography and plethysmography. Although five of seven patients continued on oral vasodilators and antiplatelet agents until the final follow-up, improvement of symptoms was maintained in all patients between intermediate- and long-term evaluations. Our results suggest that periarterial sympathectomy via the palm and wrist could prevent long-term aggravation of symptoms of chronic digital ischaemia when combined with adequate postoperative drug therapy.

Resection of peripheral branches of the posterior nasal nerve compared to conventional posterior neurectomy in severe allergic rhinitis

Transnasal resection of the posterior nasal nerve (TRPN) is the surgical procedure for drug therapy-resistant, intractable allergic rhinitis (AR). Submucous inferior turbinectomy also improves nasal symptoms in severe AR. Surgical injury to this peripheral nerve fibre may be the major cause of the decrease in allergic symptoms. During submucous turbinectomy, we have identified the peripheral branches of the posterior nasal nerve in the inferior turbinate and resected them (SRPN). The aim of this study was to evaluate the therapeutic effects of turbinoplasty with SRPN in severe AR. Improvements in subjective symptoms were compared between 13 patients who underwent SRPN with turbinoplasty (Group 1) and 11 who underwent TRPN combined with turbinoplasty and SRPN (Group 2) by retrospective chart review. Pre- and postoperative sneezing, rhinorrhea, and nasal obstruction were evaluated with questionnaires. Postoperative complications and drug therapy before and after surgery were investigated. All symptoms improved postoperatively in both groups, with no significant differences in the improvements in nasal symptom scores between the groups. SRPN combined with submucosal turbinectomy was shown to be a safe, useful, and efficient approach to patients with AR unresponsive to medical therapy. Although this is a short-term study, the results of this study suggest that SRPN represents one of the treatment options for intractable AR.

Microsurgery for Pituitary Adenomas in Adolescence

Objective: The purposes of this study were to investigate the clinical characteristics of growth hormone-secreting pituitary adenomas in adolescence and evaluate the microsurgical results in short-term (6 months) and long-term (2 years) follow-up. Methods: The clinical characteristics of 13 cases with growth hormone-secreting pituitary adenomas were reviewed retrospectively. Short-time and long-time follow-up were both done by outpatient clinic appointments, telephone, and letters. The cure and no-cure rates and the pituitary function were registered. Results: Of the 13 patients, 9 were boys and 4 were girls. Macroadenomas were found in 61.5% (8/13) of the cases, and microadenomas were found in 38.5% (5/13) of the cases. Radical tumor resection was performed for 11 patients, growth hormone was normalized in 8 patients, but assisted radiotherapy growth hormone was normalized in 11 patients. The cure rate was 84.6% (11/13) at 6 months postoperatively, and 76.9% (10/13) 2 years postoperatively. Conclusion: Microsurgery was a safe and effective therapy for growth hormone-secreting pituitary adenomas in adolescence. Postoperative radiotherapy or assisted drug therapy was often needed. However, radiotherapy should be chosen cautiously to prevent hypopituitarism.

Natural history study of postoperative residual non-functioning pituitary adenomas

To observe the postoperative residual non-functioning pituitary adenomas (PR-NFPAs) without postoperative radiotherapy and to analyze the natural history of PR-NFPAs' growth in order to provide a basis for selecting appropriate strategies of clinical treatment. We evaluated the natural history of 20 patients with PR-NFPAs who did not receive postoperative radiotherapy and drug therapy. Through MRI images, the residual tumor volumes of those patients were serially measured. We further calculated the monthly growth rate and the tumor volume doubling time (TVDT) and analyzed the correlations between the patient age, gender, volume of residual tumor, cavernous sinus (CS) invasion and TVDT. All patients received observation alone. Among which, 17 adenomas increased in volume and 3 remained unchanged during a follow-up period of 7 months to 17 years (mean 3.90 yr). The mean patient age was 41.8 years. As to 17 patients with tumor regrowth, the tumor volume at the beginning of MRI observation period was 4.73 cm(3) and tumor volume at the last MRI observation was 16.98 cm(3). During the mean 4-year follow-up period, the average monthly growth rate of PR-NFPAs was 7.87% and the mean TVDT was 724 days. Such factors as patient age, gender, volume of residual tumor and CS invasion did not affect the TVDT of PR-NFPAs. The tumor growth rate of PR-NFPAs is not significantly correlated with the patient gender, age, volume of residual tumor and CS invasion. In conjunctions with the volume of PR-NFPAs and the distance between residual adenoma and optic chiasm, we should take the TVDT into consideration and determine the appropriate and safe follow-up period.

A cross-sectional survey of the symptom experience of kidney transplant recipients

Background Previous studies have shown that being able to assess and improve kidney transplant recipients’ experience of the common side effects of long-term post-operative immunosuppressive drug therapy can positively affect their treatment compliance, and thus, their quality of life. However, more needs to be learned about the factors affecting the symptom experience of kidney transplant patients in Taiwan. Objective The purpose of this study was to further our understanding of kidney transplant recipients’ symptom experience in Taiwan in order to improve their symptom experience, drug and other therapies, and overall quality of life. Methods A cross-sectional study was conducted with purposive sampling of transplant recipients from a hospital in southern Taiwan. Data were collected from August 23, 2003 to June 30, 2004. One hundred subjects participated and self-reported using a structured questionnaire. The reliability (α) of social support and symptom experience was 0.96 and 0.78, respectively. Results The results indicated that there were significant differences in physical symptom experience by gender and herbal medicine use, and in psychosocial symptom experience by educational level and herbal medicine use. Women, on an average, had more severe physical symptoms than men. A higher level of social support and herbal medicine use was associated with less severe physical symptoms among men and women. These three factors explained 22.5% of the variance in physical symptom experience: gender (13.0%), value support (6.1%) and herbal medicine use (3.4%). The factor with the highest explanatory value for the variance in psychosocial symptom experience was herbal medicine (7.8%), its use being associated with slightly lower levels of psychosocial symptoms. Conclusions A better understanding of kidney transplant patients’ symptom experience can improve health professionals’ symptom appraisal efforts, enabling them to provide better quality care, encourage greater patient compliance, and ultimately, improve the quality of life for kidney transplant recipients.

Prognostic value of plasma N-terminal pro-brain natriuretic peptide in children with congenital heart defects and open-heart surgery

To assess whether preoperative and postoperative plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) predict postoperative outcome of open-heart surgery in children. A prospective observational study was conducted with 40 children with congenital heart defects who were undergoing elective open-heart surgery. Plasma levels of NT-proBNP, troponin T, lactate, C-reactive protein, and total neutrophil cell counts were measured before, during, and 1 and 3 hours after the end of cardiopulmonary bypass grafting (CPB). Outcomes were assessed by means of the kind, dosage, and duration of inotropic drug use during the postoperative period, lactate concentrations, and the duration of mechanical ventilation. Preoperative levels of NT-proBNP were significantly increased irrespective of the type of congenital heart defect and the age of the patient. Preoperative NT-proBNP levels were higher in patients receiving prolonged postoperative inotropic drug therapy (r = 0.56, P = .0003). By means of multivariate analysis with the duration of inotropic therapy as the dependent variable, a significant impact of preoperative NT-proBNP levels, the presence of a cyanotic heart defect, the risk adjustment for congenital heart surgery score, duration of CPB time, and postoperative lactate levels were demonstrated (R squared = 76.8%, P <.0001). Preoperative NT-proBNP levels were associated with complicated postoperative outcome in children who underwent low-risk open-heart surgery. This marker may therefore be a useful tool in risk stratification of patients with congenital heart defects.

Nausea and Dizziness after Vestibular Schwannoma Surgery: A Multivariate Analysis of Preoperative Symptoms

Nausea and dizziness are very discomforting for patients after vestibular schwannoma surgery and they impair recovery. To identify preoperative symptoms and conditions that increase the risk of development of nausea after vestibular schwannoma surgery, a multivariate analysis was performed. One hundred fifteen patients with vestibular schwannoma had a microsurgical tumor removal in a standardized procedure in 2001 and 2002. Eighteen patients were excluded from the study because of previous surgery (recurrent tumors, 7 patients) or bilateral tumor occurrence (neurofibromatosis, 11 patients). Analysis was performed regarding postoperative amount of antiemetic medication, vomiting, and subjective feeling of the patient. Tumor grading, body mass index, sex, previous complaints, examination at admission, and side of the tumor were taken in consideration. Women had significant longer postoperative complaints (mean, 3.0 d; standard error, 0.47) and needed longer antiemetic therapy (mean, 3.3 d; standard error, 0.49) than men (mean, 1.72 d; standard error, 0.21). Patients developing no significant postoperative complaints were all in the higher tumor grading group, Grades 3a, 4a, and 4b. There was a significant difference in the duration of antiemetic therapy between tumors graded 1 and tumors graded 3 or 4. Patients with a positive stepping test preoperatively had a tendency to demand less antiemetic medication. Women with small tumors are most likely to develop significant complaints after vestibular schwannoma surgery. It is possible to identify patients with a higher risk of postoperative nausea and dizziness after vestibular schwannoma surgery. This allows one to inform these patients preoperatively and to initiate an early postoperative drug therapy to ease their symptoms.

Use of low dose dopamine, gabexate mesilate and ulinastatin reduces the water balance and pulmonary complication in thoracic esophagectomy patients

In spite of improvements in surgical technique and perioperative care, severe lung complication remains as the leading cause of morbidity in thoracic esophageal cancer patients who undergo esophagectomy. The purpose of this study was to evaluate the safety and effectiveness of postoperative drug therapy using low dose dopamine, gabexate mesilate, and ulinastatin on postoperative lung complication in esophageal cancer patients. Sixty-one patients operated for esophageal cancer from 1996 to 2000 were treated postoperatively with low dose dopamine (300 microg/kg/h), gabexate mesilate (80 mg/h), and ulinastatin (300 000 unit/day) as a study group. Seventy-four patients operated from 1987 to 1994 served as an historical control group. Various preoperative and perioperative medical parameters and water balance were analyzed. Postoperative pulmonary complications were observed in 26 patients (35.1%) in the control group and three patients (4.9%) in the study group, respectively (P < 0.0001). Preoperative and perioperative variables were not significantly different between the groups. Water balance from operation to postoperative day 3 in the study group was significantly lower than the control group. Postoperative use of low dose dopamine, gabexate mesilate, and ulinastatin significantly reduced pulmonary complications after esophagectomy. This may be partly attributable to negative water balance during the early postoperative days.

Emerging techniques in the treatment of postoperative pain.

Causes of inadequate postoperative pain control, challenges with currently available analgesic therapies, characteristics of optimal postoperative analgesic therapy, a liposome-encapsulated, sustained-release dosage form of morphine, and other investigational analgesic therapies are described. Technical difficulties in analgesic drug administration, inappropriate prescribing, unfounded patient fears or expectations, and the lack of availability of parenteral dosage forms of certain analgesic agents can potentially contribute to inadequate postoperative pain control. The use of epidural catheters for analgesic therapy is limited by the use of prophylactic anticoagulation, the tendency for catheters to migrate and fail, and the need for nursing staff time to monitor the catheter site and infusion pump. Continuous peripheral blocks are not always effective, the devices used are bulky, and the technology is prone to failure. Multimodal therapies are labor-intensive, and some components must be given orally because they are not available in parenteral dosage forms. Optimal postoperative analgesic drug therapy would therefore be noninvasive, easy to administer, require no cumbersome equipment, cause no or minimal adverse effects, and be safe to use in patients receiving prophylactic anticoagulation. A new morphine sulfate sustained-release liposome injection has several of these characteristics, including ease of administration and compatibility with anticoagulation. Single-dose epidural administration of morphine sulfate sustained-release liposome injection in patients undergoing hip arthroplasty provided better pain control than i.v. opioid analgesics given by PCA, with similar adverse effects. Opioid analgesics remain the mainstay of postoperative analgesic therapy, but the development of infusion pumps with improved reliability; needle-free technologies, parenteral dosage forms of acetaminophen, selective cyclooxygenase-2 inhibitors, and other non-opioid therapies; and new opioid analgesic agents that provide analgesia without the adverse effects of currently available opioid analgesics may substantially improve postoperative analgesia and health-related quality of life in the postoperative pain patient in the future.

The Length of postoperative antituberculous therapy in patients with pulmonary tuberculosis

Background : The length of postoperative drug therapy remains controversial in pulmonary tuberculosis. We analyzed our experiences to determine the postoperative duration of chemotherapy after resection. Method : A retrospective review was performed in 66 of 95 patients that underwent pulmonary resection for pulmonary tuberculosis between January 1993 and December 1998. We compared the relapse rates according to the length of postoperative chemotherapy in each group, classified by the results of sputum AFB culture before the surgery, the number of resistant drugs, the number of prior treatment and the division of anti-TB drugs used postoperatively. Results : Fifty three of 66(80.3%) were men and 13(19.7%) were women with a median age of 33.5 years(range, 16 to 63). The mean lengths of the pre- and post-operative chemotherapies were 4.9 months, and 12.9 months respectively. Five of 66 patients (7.6%) relapsed during the mean period of follow up (39.7 months). In the group less than three times of the prior treatment, there were two relapses (20%) in Ed-the highlight above-rephrase 10 patients that were medicated for 6 months or less, and one relapse in 43 patients (2.3%) that took medicine for more than 6 months (p=0.03). In the group using second-line drugs postoperatively, there was one relapse (25%) in four patients that were medicated for 12 months or less. No patient in a total of 17 that received medicine for more than 12 months relapsed (p=0.03). Conclusion : We recommend that patients with the prior treatment less than three times should be treated for more than 6 months after resection and patients using the second-line drugs postoperatively should be medicated for more than 12 months.