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المؤلفون: Yasuko Taketa, Taro Fujitani, Yumi Irisawa
المصدر: Acta Anaesthesiologica Scandinavica. 62:1274-1279
مصطلحات موضوعية: Male, Continuous infusion, medicine.medical_treatment, Analgesic, Surgical methods, Fentanyl, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Block level, medicine, Humans, Ropivacaine, Paravertebral Block, Prospective Studies, 030212 general & internal medicine, Thoracotomy, Anesthetics, Local, Ultrasonography, Interventional, Aged, Pain Measurement, Aged, 80 and over, Pain, Postoperative, Thoracic Surgery, Video-Assisted, business.industry, Analgesia, Patient-Controlled, Nerve Block, General Medicine, Middle Aged, Analgesics, Opioid, Anesthesiology and Pain Medicine, Anesthesia, Female, Analgesia, business, medicine.drug
الوصف: Background Although several approaches for ultrasound-guided thoracic paravertebral block have been introduced, little is known regarding the differences in analgesic efficacy. We conducted this prospective randomised trial to examine whether the type of approach for ultrasound-guided thoracic paravertebral block could affect analgesic quality in thoracotomy. Methods Patients scheduled for video-assisted thoracotomy were randomly allocated into two groups by block technique: the intercostal approach (group IC) or the paralaminar approach (group PL). At the start and end of surgery, 20 mL of 0.5% ropivacaine was injected, followed by a continuous infusion of 0.2% ropivacaine at 5 mL h-1 . We also started intravenous fentanyl patient-controlled analgesia at 0.5 μg kg-1 h-1 and bolus dose of 15 μg. The main outcome was the number of rescue fentanyl use. We also evaluated postoperative pain scores and number of blocked dermatomes showing a reduced sensation. Results Enrolment was ceased because of implementation of a minimally invasive surgical method. Overall, 42 subjects completed the trial for analysis. The number of rescue fentanyl use in group PL was significantly less than that in group IC at 3, 6, 12 and 24 hour postoperatively. The numerical rating scale (NRS) at rest in group PL was significantly lower at 1, 3, 6, and 12 hour postoperatively. Patients in Group PL developed significantly wider sensory block level (median (IQR [range]); 4 (4-5 [2-7])) than those in Group IC (3 (3-3 [2-9])). Conclusions We suggested that paralaminar approach provided superior analgesia for thoracotomy rather than the intercostal approach.
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المؤلفون: Kazushi Takaishi, Satoko Sudo, Yasuko Taketa, Yumi Irisawa, Taro Fujitani
المصدر: Journal of Anesthesia. 31:271-277
مصطلحات موضوعية: Male, medicine.medical_specialty, Catheters, Transducers, Anatomical structures, Computed tomography, Thoracic Vertebrae, Catheterization, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, medicine, Humans, Paravertebral Block, Prospective Studies, 030212 general & internal medicine, Ultrasonography, Interventional, Aged, Array transducer, Pain, Postoperative, medicine.diagnostic_test, business.industry, Nerve Block, Middle Aged, Ultrasound guided, In plane, Anesthesiology and Pain Medicine, Thoracotomy, Needles, Anesthesia, Female, Radiology, Ultrasonography, Tomography, X-Ray Computed, business, Nuclear medicine
الوصف: We evaluated the analgesic feasibility of paralaminar in-plane (PL) approach for ultrasound-guided thoracic paravertebral block (USG-TPVB). As the needle trajectory was expected to be closely affected by the distance from the skin to the lamina-transverse process junction (LTPJ), we examined the correlativity between them on computed tomography (CT) or ultrasonography.Thirty-two patients undergoing thoracotomy were recruited. We measured the distances between the skin and LTPJ using preoperative CT (S-L) and procedural ultrasonography (US-L). At the beginning and the end of the surgery, 20 ml of 0.5% ropivacaine was injected. The level of sensory block and postoperative numerical pain rating scale (NRS) was assessed. Relationships among the measured parameters and the agreement of the needle depth (ND) with S-L and US-L were evaluated using Pearson's correlation coefficient and Bland-Altman analysis.S-L and US-L were strongly correlated with ND (r = 0.72 and r = 0.81, respectively) but not with BMI. The Bland-Altman analysis showed that the mean percent differences between the ND and S-L or ND and US-L were -9.6 and 20.1%, respectively. Catheters were inserted 18.6 mm lateral from the midline on average. Analgesia extended to 3-5 dermatomes in 29 patients, and the median NRS was 2 at 1, 6, 12, and 24 h after surgery, respectively.We demonstrated that PL approach provided feasible analgesia for thoracotomy and the ND was significantly correlated with the morphometric values. This technique allowed for inner catheter insertion route targeting longer anteroposterior thoracic paravertebral space length; this may reduce potential risk of pleural puncture for USG-TPVB. Trial registry number This study was registered in the UMIN Clinical Trials Registry (UMIN-CTR). (URL: http://umin.ac.jp/ctr/ , ID:UMIN000014821).
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1c6825ad706079f925b2dcaa996496be
https://doi.org/10.1007/s00540-016-2289-8 -
3
المؤلفون: Yasuko Taketa, Taro Fujitani, Yumi Irisawa
المصدر: European journal of anaesthesiology. 36(4)
مصطلحات موضوعية: Male, medicine.medical_specialty, Continuous infusion, medicine.medical_treatment, Analgesic, Thoracic Vertebrae, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, 030202 anesthesiology, law, medicine, Humans, Pain Management, Paravertebral Block, Infusions, Parenteral, Prospective Studies, Anesthetics, Local, Infusion Pumps, Ultrasonography, Interventional, Aged, Levobupivacaine, Pain Measurement, Pain, Postoperative, business.industry, Thoracic Surgery, Video-Assisted, 030208 emergency & critical care medicine, Nerve Block, Middle Aged, Analgesics, Opioid, Fentanyl, Anesthesiology and Pain Medicine, Spinal Nerves, Treatment Outcome, Cardiothoracic surgery, Anesthesia, Video-assisted thoracoscopic surgery, Intermittent bolus, Female, business, medicine.drug
الوصف: The analgesic benefits of programmed intermittent bolus infusion for thoracic paravertebral block remain unknown.The aim of this study was to compare the analgesia from intermittent bolus infusion with that of a continuous infusion after thoracic paravertebral block.A randomised controlled study.A single centre between December 2016 and November 2017. Seventy patients scheduled for video-assisted thoracoscopic surgery were included in the study.Patients were randomly assigned to receive 0.2% levobupivacaine via continuous infusion (5 ml h, continuous group) or programmed intermittent bolus infusion (15 ml every 3 h, bolus group) after an initial 15-ml bolus injection of 0.2% levobupivacaine.The main outcome was the amount of rescue fentanyl (per kg of body weight) consumed within 24 h after surgery. Secondary outcomes were postoperative pain scores, plasma levobupivacaine concentrations and the number of dermatomes anaesthetised.There was no significant difference between the continuous and bolus groups in the postoperative consumption of fentanyl (median [interquartile range] 5.5 [4 to 9.5] μg kg versus 6 [3.5 to 9] μg kg respectively, P = 0.45) and postoperative pain scores within 24 h. At 20 h after initiating the infusions, there was no statistically significant difference between the two groups in terms of the plasma levobupivacaine concentration. The number of dermatomes anaesthetised to pinprick and cold testing was significantly greater in the bolus group.Our findings suggest that postoperative pain and opioid usage are similar with either programmed intermittent bolus infusion or continuous infusion after thoracic paravertebral block. Programmed intermittent bolus infusion provides a wider sensory blockade and could benefit patients requiring a wider extent of anaesthesia.UMIN Clinical Trials Registry (UMIN-CTR; URL: http://umin.ac.jp/ctr/, ID: UMIN000023378).
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f45d73dc152dfc40fe7de10eaf8478bb
https://pubmed.ncbi.nlm.nih.gov/30664012 -
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المؤلفون: Seiji Ohigashi, Gen Shimada, Takashi Taketa, Akihiro Kishida, Hiroki Sunagawa, Keisuke Kubota
المصدر: Asian journal of endoscopic surgery. 12(3)
مصطلحات موضوعية: Laparoscopic surgery, Adult, Male, medicine.medical_specialty, Endoscope, medicine.medical_treatment, Function preservation, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Colectomy, Aged, Endoscopes, Proctectomy, business.industry, Rectal Neoplasms, General Medicine, Middle Aged, Colorectal surgery, Surgery, High resolution image, 030220 oncology & carcinogenesis, Colonic Neoplasms, High definition, 030211 gastroenterology & hepatology, Female, Laparoscopy, business
الوصف: We performed laparoscopic surgery for three cases of colorectal cancer using an 8K ultra-high-definition endoscopic system, which offers 16-fold higher resolution than the current 2K high-definition endoscope. The weight of the camera has been successfully reduced to 370 g. To maximize the advantages of the 8K ultra-high-definition endoscope, surgery was performed by darkening the room and placing a large 85-in. display as close to the surgeon as possible. As a result, the autonomic nerve was preserved, and the membrane structure could be clearly observed. Moreover, we were able to feel the stereoscopic effect near the 3-D image. This suggests the possibility of improved curability and function preservation with the 8K endoscope. Although there are some disadvantages that need to be overcome, the 8K ultra-high-definition endoscope will surely contribute to further progress in laparoscopic surgery.
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المؤلفون: Mariela A. Blum, Manoop S. Bhutani, William A. Ross, Heath D. Skinner, Jaffer A. Ajani, Stephen G. Swisher, Ritsuko Komaki, Dipen M. Maru, Hironori Shiozaki, David C. Rice, Wayne L. Hofstetter, Kazuki Sudo, Lianchun Xiao, Takashi Taketa, Roopma Wadhwa, Jeffrey H. Lee, Elena Elimova, Brian Weston
المصدر: Journal of Clinical Oncology. 32:3400-3405
مصطلحات موضوعية: Adult, Male, Cancer Research, medicine.medical_specialty, Esophageal Neoplasms, Salvage treatment, Salvage therapy, Gastroenterology, Internal medicine, Carcinoma, medicine, Humans, In patient, Aged, Aged, 80 and over, Salvage Therapy, business.industry, ORIGINAL REPORTS, Chemoradiotherapy, Definitive chemoradiotherapy, Middle Aged, Esophageal cancer, medicine.disease, Surgery, Large cohort, Oncology, Female, business, Follow-Up Studies
الوصف: Purpose Patients with esophageal carcinoma (EC) who are treated with definitive chemoradiotherapy (bimodality therapy [BMT]) experience frequent relapses. In a large cohort, we assessed the timing, frequency, and types of relapses during an aggressive surveillance program and the value of the salvage strategies. Patients and Methods Patients with EC (N = 276) who received BMT were analyzed. Patients who had surgery within 6 months of chemoradiotherapy were excluded to reduce bias. We focused on local relapse (LR) and distant metastases (DM) and the salvage treatment of patients with LR only. Standard statistical methods were applied. Results The median follow-up time was 54.3 months (95% CI, 48.4 to 62.4). First relapses included LR only in 23.2% (n = 64), DM with or without LR in 43.5% (n = 120), and no relapses in 33.3% (n = 92) of patients. Final relapses included no relapses in 33.3%, LR only in 14.5%, DM only in 15.9%, and DM plus LR in 36.2% of patients. Ninety-one percent of LRs occurred within 2 years and 98% occurred within 3 years of BMT. Twenty-three (36%) of 64 patients with LR only underwent salvage surgery, and their median overall survival was 58.6 months (95% CI, 28.8 to not reached) compared with those patients with LR only who were unable to undergo surgery (9.5 months; 95% CI, 7.8 to 13.3). Conclusion Unlike in patients undergoing trimodality therapy, for whom surveillance/salvage treatment plays a lesser role, 1 in the BMT population, approximately 8% of all patients (or 36% of patients with LR only) with LRs occurring more than 6 months after chemoradiotherapy can undergo salvage treatment, and their survival is excellent. Our data support vigilant surveillance, at least in the first 24 months after chemotherapy, in these patients.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::3e351c4f2dab7c89074644752065b976
https://doi.org/10.1200/jco.2014.56.7156 -
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المؤلفون: David C. Rice, R.U. Komaki, Manoop S. Bhutani, Takashi Taketa, Kazuki Sudo, J. H. Lee, Heath D. Skinner, Mariela A. Blum, Roopma Wadhwa, Jaffer A. Ajani, Dipen M. Maru, Lianchun Xiao, Wayne L. Hofstetter, Jeremy J. Erasmus, Brian Weston, Akihiro Suzuki, S.G. Swisher
المصدر: Annals of Oncology. 24:2854-2859
مصطلحات موضوعية: Male, Oncology, medicine.medical_specialty, Esophageal Neoplasms, Esophageal adenocarcinoma, Standardized uptake value, Adenocarcinoma, Gastroenterology, Disease-Free Survival, Clinical complete response, Internal medicine, Humans, Medicine, Prospective Studies, Pathological, Aged, medicine.diagnostic_test, business.industry, Remission Induction, Cancer, Chemoradiotherapy, Hematology, Middle Aged, Esophageal cancer, Prognosis, medicine.disease, Combined Modality Therapy, Confidence interval, Radiography, Treatment Outcome, Positron emission tomography, Positron-Emission Tomography, Female, business
الوصف: BACKGROUND Patients with localized esophageal adenocarcinoma (EAC) who achieve a clinical complete response (clinCR) after preoperative chemoradiation (trimodality therapy; TMT) or definitive chemoradiation (bimodality therapy; BMT) live longer than those who achieve a
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::7568fd2d300ff9420d2bbd6591451d22
https://doi.org/10.1093/annonc/mdt340 -
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المؤلفون: Kazuki Sudo, A. Vaporciyan, Jaffer A. Ajani, Dipen M. Maru, Manoop S. Bhutani, Lianchun Xiao, J. H. Lee, David C. Rice, Wayne L. Hofstetter, Mariela A. Blum, J. Welch, Naga Cheedella, Takashi Taketa, Akihiro Suzuki, S.G. Swisher, S.H. Lin
المصدر: Annals of Oncology. 24:1262-1266
مصطلحات موضوعية: Male, medicine.medical_specialty, Esophageal Neoplasms, Preoperative care, Cohort Studies, Stomach Neoplasms, medicine, Humans, Combined Modality Therapy, Retrospective Studies, medicine.diagnostic_test, business.industry, Remission Induction, Cancer, Retrospective cohort study, Chemoradiotherapy, Original Articles, Hematology, Middle Aged, Esophageal cancer, medicine.disease, Surgery, Treatment Outcome, Oncology, Positron emission tomography, Positron-Emission Tomography, Female, Radiology, business, Cohort study
الوصف: Chemoradiation followed by surgery is the preferred treatment of localized gastroesophageal cancer (GEC). Surgery causes considerable life-altering consequences and achievement of clinical complete response (clinCR; defined as postchemoradiation [but presurgery] endoscopic biopsy negative for cancer and positron emission tomographic (PET) scan showing physiologic uptake) is an enticement to avoid/delay surgery. We examined the association between clinCR and pathologic complete response (pathCR).Two hundred eighty-four patients with GEC underwent chemoradiation and esophagectomy. The chi-square test, Fisher exact test, t-test, Kaplan-Meier method, and log-rank test were used.Of 284 patients, 218 (77%) achieved clinCR. However, only 67 (31%) of the 218 achieved pathCR. The sensitivity of clinCR for pathCR was 97.1% (67/69), but the specificity was low (29.8%; 64/215). Of the 66 patients who had less than a clinCR, only 2 (3%) had a pathCR. Thus, the rate of pathCR was significantly different in patients with clinCR than in those with less than a clinCR (P0.001).clinCR is not highly associated with pathCR; the specificity of clinCR for pathCR is too low to be used for clinical decision making on delaying/avoiding surgery. Surgery-eligible GEC patients should be encouraged to undergo surgery following chemoradiation despite achieving a clinCR.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1aaad22461e38db14706f2f0add657fe
https://doi.org/10.1093/annonc/mds617 -
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المؤلفون: Roopma Wadhwa, Takashi Taketa, Kazuki Sudo, Akihiro Suzuki, Mariela A. Blum, Dipen M. Maru, Ritsuko Komaki, Wayne L. Hofstetter, Jeffrey H. Lee, Brian Weston, Lianchun Xiao, Heath D. Skinner, Jaffer A. Ajani, Manoop S. Bhutani, Stephen G. Swisher, David C. Rice
المصدر: Oncology. 85:95-99
مصطلحات موضوعية: Male, Cancer Research, medicine.medical_specialty, Esophageal Neoplasms, medicine.medical_treatment, Kaplan-Meier Estimate, Adenocarcinoma, Treatment Refusal, Esophagogastric cancer, medicine, Carcinoma, Humans, Aged, Retrospective Studies, Preoperative chemoradiotherapy, business.industry, Retrospective cohort study, Chemoradiotherapy, Adjuvant, General Medicine, Middle Aged, Esophageal cancer, medicine.disease, Surgery, Esophagectomy, Treatment Outcome, Oncology, Preoperative Period, Carcinoma, Squamous Cell, Female, Esophagogastric Junction, business, human activities, Chemoradiotherapy
الوصف: Background: Trimodality therapy (TMT; chemoradiation plus surgery) has level-1 evidence for survival advantage for TMT-eligible esophagogastric cancer patients. Some patients, however, decline surgery after preoperative chemoradiation. The question of which patient should have esophagectomy and which one should not is unlikely to be answered by a prospective comparison; therefore, we matched the clinical covariates of several patients who had surgery with those who declined surgery (DS). Methods: Between 2002 and 2011, we identified 623 patients in our databases. Of 623 patients, 244 patients had TMT and 61 TMT-eligible patients were in the DS group. Using the propensity-score method, we matched 16 covariates between 36 DS patients and 36 TMT patients. Results: Baseline characteristics between the two groups were balanced (p = NS). The median overall survival times were: 57.9 months (95% CI: 27.7 to not applicable, NA) for the DS group and 50.8 months (95% CI: 30.7 to NA) for the TMT group (p = 0.28). The median relapse-free survival times were: 18.5 (95% CI: 11.5-30.4) for the DS group and 26.5 months (95% CI: 15.5-NA) for the TMT group (p = 0.45). Eleven (31%) of 36 patients in the DS group had salvage surgery. Conclusions: Our results are intriguing but skewed by the patients who had salvage surgery in the DS group. Until highly reliable predictive models are developed for esophageal preservation, TMT must be encouraged for all TMT-eligible gastroesophageal cancer patients.
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المؤلفون: Linus Ho, Wei Qiao, Roopma Wadhwa, Taketa Takashi, Nishith Mewada, Mariela A. Blum Murphy, Jaffer A. Ajani, Elena Elimova, Alexandria T. Phan, Jackie Baker
المصدر: American journal of clinical oncology. 41(4)
مصطلحات موضوعية: 0301 basic medicine, Adult, Male, Cancer Research, medicine.medical_specialty, medicine.medical_treatment, Phases of clinical research, Docetaxel, Adenocarcinoma, Gastroenterology, 03 medical and health sciences, 0302 clinical medicine, Stomach Neoplasms, Internal medicine, Antineoplastic Combined Chemotherapy Protocols, medicine, Humans, Prospective Studies, Adverse effect, Aged, Cisplatin, Chemotherapy, business.industry, Middle Aged, Prognosis, Oxaliplatin, Surgery, Survival Rate, Regimen, 030104 developmental biology, Oncology, Fluorouracil, 030220 oncology & carcinogenesis, Female, Esophagogastric Junction, business, medicine.drug, Follow-Up Studies
الوصف: BACKGROUND A randomized phase III study established docetaxel, cisplatin, and 5-fluorouracil (DCF) as one of the standard treatments for patients with untreated advanced gastric cancer (AGC). However, DCF use is limited due toxicity. With the purpose to evaluate a less toxic regimen, we conducted a single arm, phase I/II trial of modified DCF (oxaliplatin, 5-fluorouracil, and docetaxel [D-FOX]) for untreated AGC patients. The primary objective of the phase I study was to determine the maximum tolerated dose of docetaxel and for the phase II study was to assess the progression-free survival (PFS) at 6 months and overall survival (OS). PATIENTS AND METHODS We enrolled a total of 98 patients with AGC. Docetaxel and oxaliplatin were administered intravenously on day 1 and 5-fluorouracil was infused starting on day 1 over 48 hours. Cycles were repeated every 2 weeks and patients were monitored for toxicities. Kaplan-Meir curve was used to estimate unadjusted OS and PFS. RESULTS The maximum tolerated dose of docetaxel was 50 mg/m. In total, 24 (45%) patients experienced grade 2 adverse events, 22 (41%) experienced grade 3, and 1 (1.9%) experienced grade 4 toxicity. The median PFS in the phase II portion of the study was approximately 6.5 (95% confidence interval, 5.5-9.5) months and the median OS was 11.1 (95% confidence interval, 9.4-18.8) months. CONCLUSIONS D-FOX administered every 2 weeks is a well-tolerated and active regimen in untreated AGC patients.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::c46b942029784cbbd3fee315f44c6ea7
https://pubmed.ncbi.nlm.nih.gov/26908161 -
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المؤلفون: Lianchun Xiao, Keith Fournier, Takashi Taketa, Akihiro Suzuki, Jeffrey H. Lee, Jaffer A. Ajani, Prajnan Das, Manoop S. Bhutani, Mariela A. Blum, Sunil Krishnan, Marc E. Delclos, Aurelio Matamoros, Brian Weston, Jeannelyn S. Estrella, Paul F. Mansfield, Pamela L. Chien
المصدر: Oncology. 82:347-351
مصطلحات موضوعية: Male, Oncology, Cancer Research, medicine.medical_specialty, urologic and male genital diseases, Disease-Free Survival, Stomach Neoplasms, Internal medicine, Humans, Medicine, In patient, Survival rate, Neoplasm Staging, Retrospective Studies, business.industry, Disease progression, Follow up studies, Cancer, Retrospective cohort study, Chemoradiotherapy, General Medicine, Middle Aged, Prognosis, medicine.disease, Surgery, Survival Rate, Treatment Outcome, Disease Progression, Female, Neoplasm staging, business, Follow-Up Studies
الوصف: Background: In patients with localized gastric cancer (LGC) who are unfit for surgery, decline surgery, or have unresectable cancer, chemoradiotherapy may provide palliation; however, data in the literature are sparse. Methods: We identified 66 LGC patients who had definitive chemoradiation but no surgery. All patients had baseline and postchemoradiation staging including an endoscopic biopsy. Multiple statistical methods were used to analyze outcomes. Results: Most patients were men and most had stage III or IV cancer. Five patients were surgery eligible but declined to have surgery. The median follow-up time was 33.9 months (95% CI 18.3–49.6). The median survival time (MST) for 66 patients was only 14.5 months (95% CI 10.8–19.7) and the median relapse-free survival (RFS) was 5.03 months (95% CI 4.67–6.40). The estimated overall survival (OS) and RFS rates at 3 years were 22.6% (95% CI 13.7–37.3) and 7.7% (95% CI 3.2–18.6), respectively. Twenty-three (35%) patients who achieved a clinical complete response (cCR; negative postchemoradiation biopsy and no progression by imaging) fared better than those who achieved less than cCR (Conclusion: Our data demonstrate that in the absence of surgery, outcomes with definitive chemoradiation are only modest. A third of the patients achieved cCR and had a longer OS and RFS than those who achieved
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