piperidines and Rectal-Neoplasms

A pooled post hoc responder analysis was performed to assess the clinical benefit of alvimopan, a peripherally acting mu-opioid receptor (PAM-OR) antagonist, for the management of postoperative ileus after bowel resection.. Adult patients who underwent laparotomy for bowel resection scheduled for opioid-based intravenous patient-controlled analgesia received oral alvimopan or placebo preoperatively and twice daily postoperatively until hospital discharge or for 7 postoperative days. The proportion of responders and numbers needed to treat (NNT) were examined on postoperative days (POD) 3-8 for GI-2 recovery (first bowel movement, toleration of solid food) and hospital discharge order (DCO) written.. Alvimopan significantly increased the proportion of patients with GI-2 recovery and DCO written by each POD (P < 0.001 for all). More patients who received alvimopan achieved GI-2 recovery on or before POD 5 (alvimopan, 80%; placebo, 66%) and DCO written before POD 7 (alvimopan, 87%; placebo, 72%), with corresponding NNTs equal to 7.. On each POD analyzed, alvimopan significantly increased the proportion of patients who achieved GI-2 recovery and DCO written versus placebo and was associated with relatively low NNTs. The results of these analyses provide additional characterization and support for the overall clinical benefit of alvimopan in patients undergoing bowel resection.

Topics: Aged; Colonic Neoplasms; Digestive System Surgical Procedures; Diverticulosis, Colonic; Female; Humans; Ileus; Intestines; Length of Stay; Male; Middle Aged; Piperidines; Postoperative Complications; Receptors, Opioid, mu; Recovery of Function; Rectal Neoplasms; Treatment Outcome

Ibrutinib is a Bruton tyrosine kinase inhibitor used in the treatment of chronic lymphocytic leukemia (CLL). Panitumumab, an mAb for epidermal growth factor receptor, is used in the treatment of metastatic colorectal cancer (CRC). We wanted to present our case where we used ibrutinib and panitumumab in combination in a patient with metachronous CLL and CRC. A 58-year-old male patient with a diagnosis of CLL was receiving ibrutinib treatment and primary rectal cancer was detected. FOLFOX + panitumumab were started when metastasis was detected in the lung after neoadjuvant chemoradiotherapy for rectal cancer. The patients used ibrutinib and panitumumab in combination. There was no cumulative or unexpected toxicity due to the combination of both antineoplastic agents. The most important point to be considered in the use of combined drugs is the evaluation of drug-drug interactions. Toxic effects of the combination of ibrutinib and cetuximab have been reported in a patient with metastatic CRC. We used ibrutinib together with panitumumab in our case and we did not encounter any cumulative or unexpected side effects during the treatment.

Topics: Adenine; Colorectal Neoplasms; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Middle Aged; Panitumumab; Piperidines; Protein Kinase Inhibitors; Rectal Neoplasms

Myasthenia gravis (MG) is an autoimmune disease affecting neuromuscular junction, which is characterized by fluctuating muscle weakness and abnormal fatigability. The use of muscle relaxants is major concern in anesthetic management for patients with MG. Muscle relaxant is a practical tool to assure immobilization during surgery under general anesthesia Anesthetic management without muscle relaxants for patients with MG is challenging, because it is difficult to assure immobilization. However, pharmacological effects of muscle relaxants can be prolonged in patients with MG, resulting in the increased incidence of postoperative respiratory support. We, here, describe an anesthetic management of an 82-year-old man with MG undergoing laparoscopic surgery. Anesthesia was induced with propofol and remifentanil Desflurane was administered via a face mask, and the patient was manually ventilated for 10 min, and the trachea was intubated safely without muscle relaxants. Anesthesia was maintained with desflurane and remifentanil. We did not administer muscle relaxants to the patient during surgery. Throughout laparoscopic procedures, no movements of the patient were observed, and there were no problems concerning the laparoscopic view of the operation filed. The surgery was uneventful. The patient emerged from anesthesia smoothly, and was extubated safely. The postoperative course of the patient was also uneventful.

Topics: Aged, 80 and over; Anesthesia, General; Contraindications; Desflurane; Digestive System Surgical Procedures; Humans; Isoflurane; Laparoscopy; Male; Myasthenia Gravis; Neuromuscular Nondepolarizing Agents; Piperidines; Rectal Neoplasms; Remifentanil

Piperine, an alkaloid phytochemical found in the fruit of black and long pepper plants, is reported to inhibit the growth of cancer cells; however, the mechanism of action in human cancer cells is not clear. In this study we investigated the effect of piperine on the growth of HRT-18 human rectal adenocarcinoma cells. MTT assays showed that piperine inhibited the metabolic activity of HRT-18 cells in a dose- and time-dependent fashion, suggesting a cytostatic and/or cytotoxic effect. Flow cytometric analysis of Oregon Green 488-stained and propidium iodide-stained HRT-18 cells showed that piperine inhibited cell cycle progression. Piperine also caused HRT-18 cells to die by apoptosis, as determined by Annexin-V-FLUOS staining and characteristic changes in cell morphology. Flow cytometric analysis of dihydroethidium- and 2',7'-dichlorofluorescein diacetate-stained HRT-18 cells showed increased production of reactive oxygen species in piperine-treated cells. Furthermore, the antioxidant N-acetylcysteine reduced apoptosis in cultures of piperine-treated HRT-18 cells, indicating that piperine-induced cytotoxicity was mediated at least in part by reactive oxygen species. The cytostatic and cytotoxic effects of piperine on rectal cancer cells suggest that this dietary phytochemical may be useful in cancer treatment.

Topics: Acetylcysteine; Adenocarcinoma; Alkaloids; Apoptosis; Benzodioxoles; Cell Cycle; Cell Cycle Checkpoints; Cell Line, Tumor; Cell Proliferation; Cytochrome P-450 Enzyme Inhibitors; Free Radical Scavengers; Humans; Mitochondria; Piperidines; Polyunsaturated Alkamides; Reactive Oxygen Species; Rectal Neoplasms; Succinate Dehydrogenase

Remifentanil, a mu-opioid receptor agonist, has important characteristics for neuroanesthesia, but data about its effects on postoperative recovery and mortality are currently lacking.. Using the Japanese Diagnosis Procedure Combination database in 2007, we selected patients who underwent elective brain tumor resection with open craniotomy under general anesthesia using either remifentanil or fentanyl and divided them into two categories: remifentanil patients and non-remifentanil patients. After propensity score matching for potential confounders, we compared the in-hospital mortality and postoperative length of stay (LOS) between the two groups. For comparison, the same endpoints were evaluated for patients underwent rectal cancer surgery under general anesthesia with intraoperative epidural anesthesia.. In patients who underwent brain tumor resection (936 pairs), remifentanil patients had significantly lower in-hospital mortality (1.5 % vs. 3.0 %; P = 0.029). Logistic regression analysis revealed that the odds ratio for use of remifentanil for in-hospital mortality was 0.47 (95 % confidence interval, 0.25-0.91; P = 0.025). Remifentanil patients also showed earlier discharge from hospital (median LOS, 17 vs. 19 days; hazard ratio, 1.19, 95 % confidence interval, 1.08-1.30; P < 0.001). In contrast, in 2,756 pairs of patients undergoing rectal cancer surgery, no significant difference was seen in either in-hospital morality (1.2 % vs. 1.3 %; P = 0.518) or median LOS (19 vs. 19 days; P = 0.148) between the two groups.. Our data suggest a possible association between use of remifentanil and better early postoperative recovery for patients undergoing neurosurgery with craniotomy. Further studies, including a randomized controlled trial, are required to confirm the present results.

Topics: Aged; Analgesics, Opioid; Anesthesia Recovery Period; Anesthesia, Epidural; Anesthesia, General; Brain Neoplasms; Craniotomy; Female; Fentanyl; Humans; Male; Middle Aged; Neurosurgical Procedures; Piperidines; Postoperative Period; Receptors, Opioid, mu; Rectal Neoplasms; Remifentanil; Retrospective Studies

Obstructive ileus is a life-threatening gastrointestinal condition that requires emergency operation. Patients with obstructive ileus sometimes develop coagulopathy. In such cases, central neuraxial blockade should be avoided. Rectus sheath blockade (RSB) is one of the popular methods for abdominal wall surgery. Ultrasound imaging of the rectus sheath may facilitate successful RSB by indicating the presence and location of rectus abdominis. Two patients presented with ileus secondary to rectal or sigmoid cancer and underwent emergency ileostomy. The patients had mild coagulopathy [platelet count, 77,000 microl(-1) in case 1, and platelet count, 98,000 microl(-1) in case 2]. Each patient underwent general anesthesia using propofol and remifentanil. They were given 0.5% ropivacaine 20ml for RSB under ultrasound-guidance. Their hemodynamics was stable and they did not need another muscle relaxant during operation, except succinylcholine during induction. RSB is useful for abdominal operations. In addition, ultrasonogrhaphy facilitates the prediction of depth of the posterior rectus sheath and improves the accuracy of local anesthetic placement. We conclude that RSB is effective for improving postoperative pain and intraoperative muscle relaxation of the abdominal wall. Ultrasound-guided RSB is an alternative method to central neuraxial blockade.

Topics: Aged, 80 and over; Anesthesia, General; Blood Coagulation Disorders; Emergencies; Female; Humans; Ileostomy; Ileus; Male; Nerve Block; Perioperative Care; Piperidines; Propofol; Rectal Neoplasms; Rectus Abdominis; Remifentanil; Sigmoid Neoplasms; Ultrasonography

We report on a 49-year-old female patient suffering from recurrent carcinoma of the rectum, who underwent a palliative Hartmann operation for an anus praeter reconstruction. After a remifentanil bolus of 90 microg and a propofol bolus of 200 mg, anaesthesia was maintained with 0.25 microg/kg/min remifentanil and 4 mg/kg propofol, and after skin incision with 1.0 microg/kg/min remifentanil and 5 mg/kg/h propofol. Throughout the operation, the patient showed a stable blood pressure of 120-130/80 mmHg but 15 min after skin incision the heart rate suddenly rose to 140 beats/min, so remifentanil was increased to 1.8 microg/kg/min and propofol to 8 mg/kg/h. Over a time period of 15 min the heart rate decreased to 90 beats/min. Subsequently vegetative parameters stayed within the normal range (heart rate 90 beats/min, blood pressure 120-130/80 mmHg) so that continuous administration of remifentanil and propofol could be tapered. After completion of skin sutures, administration of remifentanil and propofol was terminated. After extubation the patient reported having heard conversations contributable to the end of the operation and the sentence: "now we're done" was clearly remembered. The patient stated that she had not been able to move any part of her body, that she had perceived the situation as extremely unpleasant and dangerous and that she had felt severe pain. At the postoperative rounds the patient refused any psychological and psychiatric help.

Topics: Adenocarcinoma; Anal Canal; Anesthesia, General; Anesthetics, Intravenous; Awareness; Female; Hemodynamics; Humans; Middle Aged; Pain, Postoperative; Piperidines; Plastic Surgery Procedures; Propofol; Rectal Neoplasms; Remifentanil