Search

PyNPase activity, MMPs activity and serum IAP values were measured in tumor tissues from colorectal cancer patients who had been divided into two groups, one given preoperative 5'-DFUR and the controls. PyNPase activity of the preoperative administration group was approximately equivalent to that of the controls. In the control group, correlations were assessed between PyNPase activity and activities of MMP1 and MMP3. To assess the effect of 5'-DFUR on the activity of MMPs, we divided patients into two groups, a high and a low PyNPase activity group. Although there was no correlation with MMPs activity of the preoperative administration group and the control group in the low PyNPase activity group, the activities of MMP1 and MMP9 of the control group were significantly higher in the high PyNPase activity group. Moreover, the serum IAP value of the administration group was significantly lower than that of the control group. These results indicated that PyNPase activity was thus suggested to be somehow related to MMPs activity and serum IAP values.

Surgery for maxilofacial cancer is often radical and disfiguring, and therefore can have an influence on patient's interpersonal relationship and social activities. However, little is known about self-presentation of disfigured patients during rehabilitation. This is an inductive and qualitative study based on 26 extensive interviews. The results demonstrate that patients with disfigurement cope actively with problems in their interpersonal relationship and even go through the empowerment process. Self-presentation of the disfigured patients consisted of four dimensions: (1)self-evaluation: (2)judgment of others' reactions; (3)intention of personal relations and style of self-presentation; and (4) concrete self-presentation using six "strategies". Each of the dimensions 1-3 included several processes that were generally taken in sequence according to time after surgery, but also strongly influenced by behaviors of family members or medical staff. "Strategies" chosen in dimension 4 depending upon the situations in dimensions 1-3 corresponded to the five type of "self-presentation" reported by Goffman (1959), except for "letting others be used to the patients", which was one of the continuous efforts to overcome their chronic disfigurement. Importantly, the patients became confident by focusing upon their chronic disfigurement. Importantly, the patients became confident by focusing upon their healthy parts such as maxiofacial functions recovered to some degree, and this confidence led to the acceptance of disfigurement and further to the expansion of their social behaviors.

Nurses provide the psychosocial nursing care to promote the patients' empowerment. In spite of recognizing the importance of psychosocial nursing. The research reported here is part of a large study designed to explore the psychosocial nursing intervention strategies. This part of the study is focused on characteristics of psychosocial nursing care as identified by nurses. Research design was descriptive and qualitative. Subjects were a convenient sample of nurses who have more than 5 years experience and agreed to participate in this research. Data was collected through semistructured interviews. Data was recorded on a tape and transcribed, then analyzed based on Grounded Theory Approach.The number of subjects consisted of 39 nurses. The average age and duration of clinical experience was 36.6 years old and 12.6 years.Sixteen of the characteristics of psychosocial nursing to promote the empowerment among the patients were identified; 1) respect the patients' decision making, 2) clinical judgment from multiple perspectives, 3) predictability, 4) flexibility, 5) classification of the patients by comparison, 6) monitoring, 7) relief from reality, 8) relief from pain and suffering, 9) enhancement of the patients' ego strength, 10) nurture of hope, 11) support individualized daily living styles, 12) encouragement of the patients'own problem solving abilities, 13) respect of individuality, 14) self-utilization, 15) self-control based on professional identity, 16) utilization of team power.Nurses choose from the sixteen dimensions of psychosocial nursing and organizing them in order to stabilizing the patients' conditions.

We studied clinical effects of ceftazidime (CAZ) alone or in combination with aspoxicillin (ASPC) against various infections in obstetric and gynecological patients. 1. Obstetric and gynecological patients (n = 91) with various infectious diseases were treated with CAZ alone (1-2 g x 2/day, n = 54) or in combination with ASPC (1-2 g x 2/day, n = 37) administered via drip infusion. 2. CAZ alone or in combination with ASPC was efficacious in 50 out of 54 (92.6%) or 33 out of 36 (91.7%) patients, respectively. Overall, the efficacy ratios were 46/49 (93.9%) against gynecological infections, 21/25 (84.0%) against perinatal infections and 16/16 (100%) against other infections. The bacteriological efficacy ratio was 21/21 (100%) while clinical effectiveness in cases in which causative agents were known was observed in 20 out of 21 (95.2%) patients. In patients who had not respond to other treatments, CAZ alone, and in combination with ASPC were effective in 15 out of 16 (93.8%) and 6 out of 8 (75.0%) patients, respectively, hence the overall efficacy ratio was 21/24 (87.5%). 3. Abnormal values in clinical laboratory tests were obtained in 3 out of 91 (3.3%) patients. No other adverse side effects were observed in any of the patients.

The efficacy and safety of imipenem/cilastatin sodium (IPM/CS) were studied in patients with obstetric and gynecologic infections and in those given the drug as prophylaxis against postoperative infections. The following results were obtained: 1. Efficacy rates were 96.0% (48/50) in patients with obstetric and gynecologic infections and 100% (28/28) in those with urinary tract or other infections. The overall efficacy rate was 97.4% (76/78). Bacteriologically, 30 organisms were isolated from 28 patients. The eradication rate was 95.2% (20/21) and the efficacy rate was 96.4% (27/28). 2. Changes in blood elastase before and after treatment were compared with those in CRP, WBC, and ESR in the patients with obstetric and gynecologic infections. The changes in elastase were similar to those in CRP. 3. The efficacy rate was 98.0% (48/49) in the patients given prophylaxis against postoperative obstetric and gynecologic infections. 4. An adverse reaction was observed in only one patient (diarrhea), and abnormal laboratory findings were noted in 2 patients (elevation of GOT and GPT). These results indicate that IPM/CS is very useful for the treatment of obstetric and gynecologic infections.

We evaluated the clinical efficacy and safety of intramuscular (as a new route of administration) imipenem/cilastatin sodium (IPM/CS) in patients with intrauterine infections which are typical in the field of obstetrics and gynecology. The obtained results are summarized as follows. 1. Twenty-seven patients were treated with IPM/CS, 250 mg/250 mg b.i.d. (3 patients), 500 mg/500 mg b.i.d. (22) and other dosages (a change in dosing regimen, 2). The duration of treatment ranged from 3 to 11 days and the total dosage during an entire course of treatment varied from 1.5 to 9.0 g. The drug was suspended in a lidocaine solution and administered in the gluteal muscle of the patients. 2. Clinical efficacies were excellent in 7 patients (26%), good in 19 (70%) and poor in 1 (4%) and the overall efficacy rate was 96.3%. All of the 8 patients who had not previously showed improvements with treatment by other antibiotics responded well to this drug. 3. Bacteriologically, the clinical efficacy rate was 95.8% (23/24) and the eradication rate was 76.2% (16/21). 4. No adverse effects due to the drug were observed. As abnormal laboratory test results, transient elevations of GOT and GPT were noted in one patient.

Clinical effects of combined use of aztreonam (AZT), amikacin (AMK) and clindamycin (CLDM) in 46 cases with infectious diseases in obstetrics and gynecology were retrospectively studied in 2 groups, and the following results were obtained. 1. No significant difference in efficacy rates was noted between AZT plus CLDM treated group (n = 25) and AMK plus CLDM treated group (n = 21) (96.0% vs. 95.2%), while rate of excellent efficacy was slightly higher in AZT plus CLDM group than AMK plus CLDM group (24.0% vs. 14.3%). 2. No significant difference in bacteriological clinical effects was also noted between the 2 groups, while bacteriological eradication rate was higher in the AZT plus CLDM group than in the other group (76.2% vs. 50.0%), and the difference was particularly clear in the eradication rates of aerobic, Gram-negative bacteria (88.9% vs. 30.0%). 3. Subjective and objective side effects, and abnormalities of clinical test results were not found in either group.

A 56-year-old woman was diagnosed as having gastric cancer with lymph node metastasis and invasion to the pancreas head and was admitted to our hospital in September, 1984. She was treated with hyperthermo-chemo-radiotherapy, using radiofrequency-induced hyperthermia (8 MHz) with a daily dose of fractionations at 42-43 degrees C for 60 minutes, 5 fractions per week of irradiation at 180 cGy and systemic chemotherapy. After the total doses of hyperthermia and radiation had reached 11.8 hours and 2500 cGy, the primary tumor and lymph node metastasis measured by X-ray examination were reduced in size. On October 8th, laparotomy was done, and total gastrectomy combined with total pancreatectomy, left hepatic lobectomy and right hemicolectomy was performed. Histologically, almost all of the cancer cells in the primary tumor and lymph node metastasis had disappeared. These results show that this multimodal therapy is effective for local control of gastric cancer, when used preoperatively.

Urinary adrenaline and noradrenaline concentrations were determined at 38-41 wks of gestation, admission for the onset of labor, 4 hrs after admission and at the cervical dilatation of 8-10 cm, immediately after delivery and on the next morning. Both catecholamine concentrations rose remarkably at the dilatation of 8-10 cm and were found to be still high immediately after delivery. The rise in adrenaline concentrations was much greater than noradrenaline. On the morning after delivery, the adrenaline concentrations fell significantly but noradrenaline remained high. The time-course of urinary catecholamines was similar to that of plasma reported by others. Serum cortisol concentrations rose significantly during labor and delivery but returned to the concentrations of 38-41 wks of gestation by the next morning. The present time course of adrenaline, noradrenaline and cortisol levels in urine or serum during labor, delivery and puerperium suggests that these hypersecretion may be due to emotional, physical and painful stress, respectively, considering literatures.

A 72-year-old woman developed adenocarcinoma of the left parotid gland. Because of the excessive size of her tumor and the fact that she suffered from severe liver dysfunction, she was treated by hyperthermo-chemo-radiotherapy (HCR therapy). After ten sessions of radiofrequency hyperthermia with HEH 500 (13.56 MHz radiofrequency wave), 50-Gy irradiation from a linac and administration of 33.0g of tegafur in suppository form, the tumor mass showed remarkable regression decreasing in size by as much as 84% on computed tomography. Histologically the tumor which was resected under local anesthesia, showed almost total necrosis. The multidisciplinary HCR therapy was well tolerated and effective as a therapy for cancer in this case.

A 56-year-old woman with recurrent gastric cancer treated with PMU therapy, combined CDDP 75 mg/m2 i.v. MMC 10 mg/body i.v. and UFT 400mg/body/2 alpha/day p.o., was reported. She was admitted because of cervical lymph node swelling and abdominal tumor (para-aorta lymph node swelling). She was treated two times with this therapy and induced into complete remission. The serum CEA level, more than 500 ng/ml before the treatment, was reduced to 6.7 ng/ml after treatment. She has currently been free of disease for more than four weeks. We conclude that this PMU therapy is extremely effective for indurable gastric cancer.

Thirty-four patients with advanced gastric cancers had received continuous hyperthermic peritoneal perfusion (CHPP) for prevention or treatment of peritoneal dissemination (PD). These patients received intra-abdominal perfusion 30-40 minutes by about 10-liter saline heated to 50-52 degrees C dissolving 200-300 mg cisplatin (CDDP) and 20-30 mg mitomycin C (MMC). The perfusate was infused in the peritoneal cavity through the peritoneal cavity expander (PCE Nihon Kayaku Co. Ltd.) newly developed for sufficient irrigation in our clinic. Eleven patients with macroscopic serosal invasion without PD (P0) or with mild PD (P1) underwent prophylactic CHPP for prevention of peritoneal recurrence. (Pn means degree of PD according to The General Rules for the Gastric Cancer Study.) Twenty-three patients with moderate PD (P2) or severe PD (P3) underwent therapeutic CHPP. The prognosis of patients having undergone prophylactic or therapeutic CHPP (CHPP (+) group) was compared with those not having done CHPP (CHPP (-) group) in the historical control study. In the prophylactic study two-year-survival rates of CHPP (+) group was 90% significantly higher than 63% in CHPP (-) group. There was no significant difference between two-year-survival rates of CHPP (+) (11%) and CHPP (-) (0%) in the therapeutic CHPP. But ascites was observed to disappear in five of twelve (41.7%). Surprisingly second look operation disclosed macroscopic and microscopic disappearance of PD in three of nine (33.3%). The side-effects in those patients had consisted of leakage, bone marrow suppression, perforation of small bowel and so on. But there was no mortality after introduction of PCE. About laboratory data, rises in WBC, BUN, creatinine and LDH and drops in total lymphocytes counts and platelets were all normalized within four weeks. The maximal concentrations of total and free, which emerged at five minutes after CHPP, were 2.19 and 1.29 micrograms/ml. These results suggested that CHPP with CDDP and MMC was well tolerated and effective for prevention of peritoneal recurrence and treatment of peritoneal dissemination in the gastric cancer.

One hundred and fifty patients with malignant ovarian tumors were treated in the Cancer Institute Hospital between 1949 and 1977. Most (103; 68.7%) of the patients had simple primary ovarian cancer. A retrospective study was performed in these 103 patients to investigate the relationship between the 5-year survival rate and the clinical stage and primary treatment. The 103 patients were classified according to FIGO criteria. The survival rates for stages I, II, III and IV were 73.7%, 50.5%, 17.4% and 0%, respectively. As the primary treatment, operations were performed on 92 of the 103 patients. To conclude, of primary importance in the treatment of ovarian cancer is the surgical, complete as possible removal of the tumors. Postoperatively, radiotherapy and chemotherapy should be used. Recently, second look operations have come into wider use. General procedures for the surgical and postoperative treatment of progressive ovarian cancer have been established. Although surgical procedures for the treatment of early ovarian cancer have also been established, there are no consistent procedures for postoperative treatment. Since the incidence of ovarian cancer is increasing, the development of appropriate methods for early diagnosis and treatment of this carcinoma is eagerly awaited.

A continuous hyperthermic peritoneal perfusion using high-dose cis-diamminedichloroplatinum (CDDP) and its antidote, sodium thiosulfate, was applied to eight patients with peritoneal metastasis from gastric cancers. Two of eight patients showed partial response and the rate of decrease of ascites was 38%. Renal failure and leukopenia were observed in one and two patients, respectively, but no severe or lethal dysfunction was observed and all were tolerated. These results showed that CDDP exerted anti-tumor effects on peritoneal metastasis from gastric cancers when used in high doses in combination with hyperthermia.