Toyoshi Hosokawa

Effects of near-infrared low-level laser irradiation on microcirculation.

Recently, there has been an increase in the clinical application of low‐level laser irradiation (LLLI) in various fields. The present study was conducted to explore the effects of LLLI on microcirculation.

The effect of postoperative analgesia with continuous epidural bupivacaine after cesarean section on the amount of breast feeding and infant weight gain

The purpose of this study is to determine the effect of postoperative analgesia on the amount of breast feeding and infant weight gain.Thirty parturients undergoing elective cesarean section under spinal anesthesia were randomly allocated to receive postoperative pain management with (S-E group, n = 15) or without epidural bupivacaine (S group, n = 15). Epidural analgesia was performed for 3 days with a continuous epidural infusion (0.7 mL/h) of 0.25% bupivacaine. Diclofenac was available on demand in all patients. The weight of milk fed by breast and the infant weight were measured for 11 days after cesarean section. In the S-E group, the visual analog pain score after surgery was significantly lower and both the weight of milk fed by breast and the infant weight during the study were significantly more than the respective values in the S group. The S group required a larger dose of diclofenac after the operation than did the S-E group. We suggest that satisfactory postoperative pain relief with continuous epidural bupivacaine for 3 days after cesarean section improved the amount of breast feeding and the gain of infant weight. (Anesth Analg 1996;82:1166-9)

Opioid Rotation from Oral Morphine to Oral Oxycodone in Cancer Patients with Intolerable Adverse Effects: An Open-Label Trial

OBJECTIVE We prospectively investigated the efficacy of opioid rotation from oral morphine to oral oxycodone in cancer patients who had difficulty in continuing oral morphine treatment because of inadequate analgesia and/or intolerable side effects. METHODS Twenty-seven patients were enrolled and 25 were evaluated. The rate of patients who achieved adequate pain control, which provided an indication of treatment success, was evaluated as primary endpoint. The acceptability and pharmacokinetics of oxycodone were evaluated in addition to the assessment of analgesic efficacy and safety during the study period. RESULTS In spite of intense pain, the morphine daily dose could not be increased in most patients before the study because of intolerable side effects. However, switching to oral oxycodone allowed approximately 1.7-fold increase as morphine equivalent dose. Consequently, 84.0% (21/25) of patients achieved adequate pain control. By the end of the study, all patients except one had tolerated the morphine-induced intolerable side effects (i.e. nausea, vomiting, constipation, drowsiness). Common side effects (>10%) that occurred during the study were typically known for strong opioid analgesics, and most were mild to moderate in severity. A significant negative correlation between creatinine clearance (CCr) value and the trough concentrations of the morphine metabolites was observed. On the other hand, no significant correlation was found between CCr value and the pharmacokinetic parameters of oxycodone or its metabolites. CONCLUSIONS For patients who had difficulty in continuing oral morphine treatment, regardless of renal function, opioid rotation to oral oxycodone may be an effective approach to alleviate intolerable side effects and pain.

Epidural anaesthesia blocks changes in peripheral lymphocytes subpopulation during gastrectomy for stomach cancer

To examine the effects of surgery and anaesthesia on cell‐mediated and humoral immunity, we investigated changes in subpopulations of peripheral T cells and B cells during gastrectomy. Twenty‐one patients with gastric cancers who underwent total or subtotal gastrectomy were randomly assigned to receive thiopental/N2O general anaesthesia supplemented with either epidural (epidural group, n=12) or enflurane(enflurane group, n=9). The changes in peripheral lymphocyte subpopulations were detected and quantified using single and double label analysis of monoclonal antibodies against lymphocyte membrane surface markers (Leu series). Subpopulations were measured before induction, and 1 and 2 hours after skin incision. In the enflurane group, B cells (Leu12+), total T cells (Leu4+), inducer T cells (CD4+, Leu8+) and the CD4/CD8 ratio decreased and suppressor T cells (CD8+, Leu15+) increased significantly after skin incision. Whereas, the epidural group showed no change in the number of B cells and each T cell subpopulation during the study. These data suggest that epidural anaesthesia blocks the effect of stress induced by major surgery on fluctuation of peripheral lymphocyte subpopulations which may be associated with suppression of immunity.

Statistical identification of predictors for peripheral neuropathy associated with administration of bortezomib, taxanes, oxaliplatin or vincristine using ordered logistic regression analysis.

Chemotherapy-induced peripheral neuropathy (CIPN) is a major drug-induced adverse reaction that becomes a dose-limiting toxicity. However, effective strategies for preventing or treating CIPN are lacking. Accordingly, this study aimed to statistically identify predictors for CIPN. Retrospective analysis was carried out for 190 patients who had been treated with bortezomib (n=28), taxanes (paclitaxel or docetaxel; n=58), oxaliplatin (n=52) or vincristine (n=52) at our hospital between April 2005 and December 2008. The severity of CIPN was assessed at the time of chemotherapy completion, graded as grade 0–5 in accordance with the National Cancer Institute Common Terminology Criteria for Adverse Events v3.0. Multivariate ordered logistic regression analysis was used to investigate predictors for CIPN. Predictors for CIPN in patients that were administered bortezomib were no co-administration of dexamethasone [odds ratio (OR), 0.455; confidence interval (CI), 0.208–0.955; P=0.0376] and sex (male) (OR, 3.035; CI, 1.356–6.793; P=0.0069). For taxanes (paclitaxel or docetaxel), the predictor for CIPN was a large number of chemotherapy cycles (OR, 2.379; CI, 1.035–5.466; P=0.0412). For oxaliplatin, the predictors for CIPN were a large number of chemotherapy cycles (OR, 3.089; CI, 1.598–5.972; P=0.0008) and no co-administration of non-steroidal anti-inflammatory drugs (OR, 0.393; CI, 0.197–0.785; P=0.0082). For vincristine, predictors for CIPN were a large number of chemotherapy cycles (OR, 6.015; CI, 1.880–19.248; P=0.0025) and co-administration of an analgesic adjuvant (OR, 3.907; CI, 1.383–11.031; P=0.0101). In conclusion, our study indicates that CIPN will be alleviated by the co-administration of dexamethasone with bortezomib and non-steroidal anti-inflammatory drugs with oxaliplatin.

Efficacy of Goshajinkigan for Oxaliplatin-Induced Peripheral Neuropathy in Colorectal Cancer Patients

Objective. To evaluate the efficacy of Goshajinkigan for oxaliplatin-induced peripheral neuropathy in colorectal cancer patients. Patients. Colorectal cancer patients (N = 29) who received ≥4 weeks of Goshajinkigan for oxaliplatin-induced peripheral neuropathy during chemotherapy at Kyoto Prefectural University of Medicine were (Goshajinkigan group) compared to 44 patients who had not received Goshajinkigan during the same period (non-Goshajinkigan group). Main Outcome Measures. The effect of Goshajinkigan was graded as curative, effective, stabilizing, or deleterious. The relationships between the grade of peripheral neuropathy and the dose of oxaliplatin in the Goshajinkigan and non-Goshajinkigan groups were evaluated. Results. The effect of Goshajinkigan on peripheral neuropathy in the Goshajinkigan group was curative, effective, stabilizing, and deleterious in 3.4, 20.7, 69.0, and 6.9% of patients, compared to the effect in the non-Goshajinkigan group (4.5, 15.9, 45.5, and 34.1%). The ratio of deleterious effects was significantly different between these two groups (P = 0.04). A Kaplan-Meier analysis in relation to the cumulative dose of oxaliplatin showed that the incidence of grade 3 peripheral neuropathy tended to be less in the Goshajinkigan group (P = 0.05). There were no significant differences in time to treatment failure and severe adverse events between these two groups. Conclusions. Goshajinkigan prevented exacerbation of oxaliplatin-induced peripheral neuropathy. This trial is registered with UMIN000009956

Heart rate variability during chemical thoracic sympathectomy.

Background Chemical thoracic sympathectomy (CTS) resulted in profound bradycardia in a patient with severe posttherapeutic neuralgia. To clarify the cause of this bradycardia, the authors evaluated heart rate variability using a Poincare plot, which is a scatter diagram of the current R-R interval plotted against the R-R interval immediately preceding it, in this patient and in others scheduled for CTS or mandibular block (MB). Methods Twenty-three patients were scheduled for CTS (n = 13, CTS group) and for MB (n = 10, MB group). Heart rate and the SD of the R-R interval variabilities spreading along the x axis (SDRR) and perpendicularly along the diagonal line of the Poincare plot (SD sub [partial differential] RR) were evaluated before, just after, and 1 h after the block. Results Neither group had significant changes in heart rate. The MB group showed no significant change in the SDRR:SD sub [partial differential] RR ratio. In the CTS group, however, the SDRR:SD sub [partial diffenrential] RR ratio decreased significantly from 1.72 +/- 0.20 to 1.23 +/- 0.11 just after CTS. The previous patient, who had a high SDRR:SD sub [partial diffenrential] RR ratio of 3.45 before CTS, exhibited severe bradycardia (22 beats/min). Conclusions The SDRR:SD sub [partial diffenrential] RR ratio decreased after CTS without any significant concomitant change in heart rate. The decrease in the SDRR:SD sub [partial diffenrential] RR ratio indicates a reduction of cardiac sympathetic activity. However, CTS in patients having high SDRR:SD sub [partial diffenrential] RR ratios can result in profound bradycardia.

The effect of the partial pressure of oxygen on blood glucose concentration examined using glucose oxidase with ferricyan ion.

Glucose oxidase with ferricyan ion (GOD-F) is widely applied in clinical settings as a glucose sensor. However, blood oxygen concentration affects this blood glucose value because oxygen, at increased concentrations, consumes blood glucose, which cannot then be measured by this sensor. We investigated the effect of Po2 on blood glucose concentration in 48 patients who were breathing high concentrations of oxygen. Arterial and pulmonary arterial blood glucose values were analyzed using the GOD-F method and, as a control, the hexokinase method. The respective Po2 values were also measured. The blood glucose concentrations measured by the GOD-F method show a significant linear relation with that measured by the hexokinase method in both arterial (y = −24.4 + 1.01x, r = 0.99) and pulmonary arterial blood (y = −3.4 + l.01x, r = 0.96). The difference of intercepts is statistically significant, but because of the relatively large limits of agreement indicating any hidden extraneous variabilities, the error of the GOD-F method could not be assessed just by the difference. The equation defining the effect of Po2 on the percent change between blood glucose measured by the GOD-F method and that measured by the hexokinase method is −19.8/(1 + 203900/Po2268) (r = 0.62). This formula generally follows our measured materials and introduces the relationship among blood glucose value, Po2, and the error of the GOD-F method. We hesitate to suggest that the arterial blood glucose concentration when measured by the GOD-F method could be underestimated by as much as 20% in patients with high arterial oxygen pressure. The underestimation is not a clinical problem when blood glucose is high, but anesthesiologists should pay attention to easy evaluation of hypoglycemia by the GOD-F method when blood Po2 is high.

Predictive factors for postherpetic neuralgia using ordered logistic regression analysis.

Objectives:To identify predictive factors for the occurrence of postherpetic neuralgia (PHN). Methods:The participants were 73 herpes zoster patients who had been treated at the pain clinic of our hospital between January 2008 and June 2010. Variables present at the initial visit were extracted from the clinical records for regression analysis of factors related to the occurrence of PHN. The following scores for response were used: 0=no PHN after 3 months; 1=PHN present after 3 months but absent after 6 months; and 2=PHN present after 6 months. Multivariate ordered logistic regression analysis was performed to identify the predictive factors for PHN. Results:Advanced age [odds ratio (OR)=2.740, confidence interval (CI)=1.110-6.761; P=0.0288] and deep pain (OR=4.244, CI=1.114-16.163; P=0.0341) at the initial visit to our outpatient pain clinic were found to be significant predictive factors for the occurrence of PHN. Diabetes mellitus (OR=3.075) and pain reduced by bathing (OR=3.389) also had high OR, although they were not significant. Discussion:Our study indicates that advanced age and deep pain at the initial visit are significant predictors for PHN. Our results are considered likely to contribute to the establishment of evidence-based medicine in the optimal treatment of PHN.

Factors predicting requirement of high-dose transdermal fentanyl in opioid switching from oral morphine or oxycodone in patients with cancer pain.

ObjectivesTo identify predictive factors requiring high-dose transdermal fentanyl in opioid switching from oral morphine or oxycodone to transdermal fentanyl in patients with cancer pain. MethodsThe participants were 76 hospitalized terminal cancer patients who underwent opioid switching from oxycodone or morphine sustained-release tablet to transdermal fentanyl at our hospital between January 2009 and June 2010. The conversion dose was calculated as transdermal fentanyl (25 &mgr;g/h)/oral morphine (60 mg) or oxycodone (40 mg)=1. The response evaluated was the dose conversion ratio [transdermal fentanyl/oral morphine or oxycodone (conversion dose to fentanyl)]=Y and was taken to be 0 for Y⩽1, 1 for 1<Y⩽2, 2 for 2<Y⩽3, and 3 for 3<Y. Predictors evaluated were factors potentially impacting pain. Ordered logistic regression analysis was carried out to identify the predictive factors requiring high-dose transdermal fentanyl in opioid switching. ResultsBreast cancer [odds ratio (OR)=8.218; 95% confidence interval (CI), 1.219-55.407; P=0.0305], total protein level (OR=0.630; 95% CI, 0.408-0.974; P=0.0377), alanine aminotransferase level (OR=1.017; 95% CI, 1.001-1.033; P=0.0390), advanced age (OR=3.700; 95% CI, 1.360-10.063; P=0.0104), and male sex (OR=3.702; 95% CI, 1.355-10.115; P=0.0107) were found to be significant predictive factors requiring high-dose transdermal fentanyl in opioid switching. DiscussionOur study indicates that breast cancer, total protein, alanine aminotransferase, advanced age, and male sex are significant predictors of a need for higher dose transdermal fentanyl in opioid switching. Our results are considered likely to contribute to the establishment of evidence-based medicine in pain relief and palliative care.