Hideo Kashiwagi

Gallbladder tissue concentrations, biliary excretion and pharmacokinetics of OPC-17116.

OPC-17116 is a new oral carboxylic acid quinolone antibacterial agent synthesised by Otsuka Pharmaceutical Co., Ltd. Antibacterial assessment has shown that OPC-17116 possesses a broad spectrum of in vitro activity against Grampositive and Gram-negative bacteria, including anaerobes, with particularly potent activity against aerobic Gram-positive bacteria and anaerobes.[l] Preliminary pharmacokinetic assessments in healthy adult volunteers have shown that plasma OPC-17116 concentrations increase dose dependently after oral administration at doses of 100 to 400mgP]Its elimination half-life (10 to 12 hours) is longer than that of most quinolones, thus indicating the possibility of once-daily administrationP] No drug accumulation was noted after repeated administration. [2] A high rate of tissue distribution has been observed after oral administration in animal studiesJ3] In human studies, the compound was excreted primarily via the bile; urinary excretion of unchanged compound was 10 to 12% of the administered dose during the period 0 to 72 hours after oral administration. Since OPC-17116 possesses a broad spectrum of antibacterial activity, it may be clinically useful in the treatment of biliary tract infections. This study was conducted to determine the pharmacokinetics of OPC-17116, and particularly its concentrations in bile and gallbladder tissue, and the extent of its biliary excretion. 1. Methods

Three Cases of Laparoscopic Cholecystectomy by Double Scope Method.

腹腔鏡の1方向からの平面画像ではCalot三角部での総胆管の同定が難しく, 胆管損傷を起こしかねない.そこで, 剣状突起下の10mmのトラカールと鎖骨中線上の5mmのトラカールの間に第5の5mmのトラカールを増設し, それを介し5mm径の第2の腹腔鏡を挿入して, double scope下に胆嚢摘出術を行った.Double scope法により,(1) 開腹術とほぼ同じ方向からCalot三角部が観察でき, 総胆管の走行の確認が容易となり,(2) 胆嚢管と胆嚢動脈が2方向から十分同定でき, クリッピング, 切離の際の余分な組織の混入が防止でき,(3) 胆嚢管のクリッピングの位置の決定に有用であった.さらに,(4) 第1の臍部よりの腹腔鏡では視野が接線方向となって見づらくなる肝下面の癒着部が第2の腹腔鏡により直視でき, 結腸や十二指腸を十分確認しつつ, 安全に癒着剥離が行えた.