We investigated the current status and problems of cancer pain relief, sedation for cancer pain and uncontrolled symptoms in patients with recurrent gastric cancer. The subjects of this study were 59 patients with recurrent gastric cancer undergoing palliative treatment in the Department of Surgery of our hospital. We retrospectively examined the modality of cancer pain relief, use of sedation and the reason for sedation. Outpatient treatment lasted 0-682 days (mean ; 195.3 days) and hospitalization 1-117 days(mean ; 32.1 days). Nonsteroidal antiinflammatory drugs were used for all patients. Morphine was administered to 50 patients (84.7%). Analgesic effects were seen in all patients. No servere adverse events occurred. Sedation was used in 33 (55.9%) for general fatigue (28) and/or restlessness (17). We concluded that analgesia was sufficient and safe with nonsteroidal antiphlogistic and pharmaceutical morphines, but about half of the cases required sedation.
cancer pain ; Sedation procedure ; Gastric cancer recurrent ; therapeutic aspects ; symptoms <1>

A 40-year old man with chest pain was admitted to our hospital. A three-dimensional CT revealed an unruptured left coronary sinus of Valsalva aneurysm and mild stenosis of the left main trunk. An echocardiogram revealed severe aortic regurgitation. He was operated on with an aortic root replacement procedure. Though the procedure was itself uneventful, he could not be weaned from cardiopulmonary bypass because of unexpected coronary events ; relative stenosis of the RCA and stretched LMT due to a huge aneurysm of the sinus of Valsalva. Additional CABG with LITA to LAD and SVG to RCA led to weaning from cardiopulmonary bypass. Left coronary sinus of Valsalva aneurysm is rare, and it requires early surgical intervention for an increase in the diameter of the aneurysm together with myocardial ischemia due to compression of the coronary artery.

A 56-year-old man had aneurysms of the right subclavian artery and cerebral artery in association with congenital absence of the right internal carotid artery. The aneurysm of the subclavian artery was successfully surgically repaired through a partial sternotomy. Congenital absence of the internal carotid artery is rare vascular anomaly. This anomaly contributes to the occurrence of intracranial aneurysms. However, aneurysm of subclavian artery associated with congenital absence of the internal artery is very rare. This is the 3rd case reported in the literature.

A 16-year-old high school boy experienced intermittent claudication of his left lower limb during boxing training. Physical examination revealed a cold left foot and diminished pulse. A 64-row multi-slice CT (MSCT) demonstrated lateral shift and severe stenosis of the left popliteal artery due to malposition of the medial head of the gastrocnemius muscle. A diagnosis of popliteal artery entrapment syndrome (Delaney type II) was established and a surgical correction was planned. During surgery, since the artery was found to be compressed but not occluded, we simply released the popliteal artery by division of the medial head of the gastrocnemius and abnormal flips of muscle. The postoperative ankle brachial pressure index rose from “not measurable” to 1.22. MSCT was useful to characterize this anomaly by expressing the precise anatomical relation of muscle, bone and artery, which was a good guide for an appropriate surgical intervention.

Pulse wave velocity is widely used as an index of arterial stiffness. The aim of this study is to assess the usefulness of pulse wave velocity as a risk factor in patients who underwent coronary artery bypass grafting. Arterial stiffness was measured by brachial-ankle pulse wave velocity (baPWV) and the ratio of the patient's baPWV to the age-matched normal value was calculated in 42 CABG patients. Age and male/female ratios were 66.7 years and 33/9, respectively. baPWV (1, 820.7±459.8cm/s) was higher in CABG patients than that in age-matched normal value. Preoperatively, the baPWV ratio in the group with the history of cerebrovascular disease was significantly higher than that in the group who had no cerebrovascular disease (p<0.05). In contrast, the baPWV ratio did not correlate to the severity of other cardiovascular diseases. There was one (2.4%) in-hospital death and 23 incidences of postoperative complication in 16 patients. The baPWV ratio in the group with postoperative complications was significantly higher than that in the group with no complications (1.38±0.33 vs. 1.16±0.22; p<0.05). In this study, baPWV in CABG patients was higher compared with that in the age-matched general population, indicating the existence of atherosclerotic vascular changes. The elevated bePWV is also a risk factor of postoperative complications in patients who have undergone CABG.

We report a patient who underwent an operation for an infectious abdominal aortic aneurysm 10 months after intravesical bacillus Calmette-Guerin therapy. A 68-year-old man had previous gastrectomy for early gastric cancer and intravesical BCG therapy for early stage urinary bladder cancer. His follow up CT scan revealed an abdominal aorta pseudoaneurysm. We performed aneurysmectomy, omentopexy and bilateral axillo-femoral bypass. The culture of an abscess in the aneurysm identified Mycobacterium bovis. The patients improved clinically with antituberculosis agents after operation. Intravesical bacillus Calmette-Guerin therapy is effective in the treatment of early stage urinary bladder cancer. Although this treatment is generally considered safe, serious complications including vascular complications have been reported.