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To determine factors related to the effectiveness of red blood cell transfusions in terminally ill cancer patients, we conducted a retrospective cohort study. We studied 27 terminally ill cancer patients who were transfused with red blood cells at our hospitalbetween June 2015 and September 2017. Patients who responded to the treatment("responders"; 16 cases[59%]) were compared with those who did not("non-responders"; 11 cases[40%]). Comparative predictive factor analysis revealed statistically significant differences between responders and non-responders in Eastern Cooperative Oncology Group performance status(PS)(p=0.004)and palliative prognostic index(PPI)scores(p=0.022). Furthermore, a statistically significant difference in median post-transfusion survivaltimes(MST)(p=0.047)was found between responders(69 days; quartile range: 20-141 days)and non-responders(22 days; quartile range: 11-47 days). These results suggested that PPI and PS were significant predictors of the effectiveness of red blood cell transfusions in palliative care, and transfusion effectiveness was related to post-transfusion survivaltime.

The palliative care, methodologies, and evaluation methods of clinical study for chemotherapy-induced nausea and vomiting( CINV)are not defined well. In addition, it is important to consider that individualized antiemetic therapy should be treated according to each patient's risk factors as well as the emetogenicity of chemotherapy regimens. While the CTCAE is being widely used by medical staff in clinical practice for the evaluation of CINV, the patient-reported outcome(PRO)is also considered as an important method of assessment. In this article, we describe matters to consider during the process of designing, evaluating, and applying in a clinical setting for CINV study. Based on "Supportive care and policy of palliative care CINV" which is going to be published, we expect that clinical study designs would be optimized to accelerate the establishment of evidence by utilizing not only randomized controlled trial(RCT), but also real world data(RWD).

A 70-year-old man with a past history of lung resection for early stage lung cancer was admitted to our hospital because of worsening exertional dyspnea. Right heart catheterization revealed severe pulmonary arterial hypertension (PAH) with pulmonary vascular resistance of 1671.64 dyne.sec.cm(-5). The patient was treated with sildenafil added to an oral prostacyclin analog, beraprost, and long term oxygen therapy. His exertional dyspnea continued to improve until his sudden death following nasal bleeding. Autopsy revealed marked thickening of pulmonary arteriolar walls, but no recurrence of lung cancer, significant pulmonary embolism or pulmonary parenchymal disease. His PAH could not be explained by the mild airway obstruction or sleep apnea syndrome, and unrelated pulmonary vascular disease was suspected.

The incidence and duration of hoarseness following tracheal intubation with general anesthesia were studied retrospectively from November 1998 to October 2000 in postanesthetic clinic of Nara Medical University. Total number of patients was 3977 and 37.1% of them complained of hoarseness. Most of there patients recovered within three days after surgery but in 4.2% the hoarshness persisted over ten days and in 0.7% persisted over one month after surgery. Most of these persistent hoarseness were considered to have originated from surgical procedures (such cervical, pulmonary, cardioaortic operation, etc.) and those following only tracheal intubation recovered within two months after surgery. The hoarseness decreased the satisfactory level for anesthesia in 1.0% of total patients and 12.8% of patients with persistent hoarseness. We consider that preoperative explanation and postoperative communication by anesthesiologists are important.

Rhabdomyolysis is one of the perioperative complications in patients with Duchenne's muscular dystrophy (DMD). It has been suggested that sevoflurane can be used safely for anesthesia in patients with DMD. In this report, we describe a case with DMD who received anesthesia with sevoflurane, in which rhabdomyolysis developed postoperatively. A 6-year-old boy diagnosed as DMD was scheduled for tonsillectomy under general anesthesia. Preoperative laboratory examination revealed a high level of creatine kinase (CK) (16,000-32,000 IU.l-1). An abnormality of the dystrophin gene was detected by DNA analysis. Anesthesia was induced with sevoflurane without muscle relaxant, and maintained with sevoflurane in nitrous oxide and oxygen under controlled ventilation. The course of anesthesia was uneventful and the patient recovered smoothly. Three hours postoperatively, dark red urine with a high concentration of myoglobin (1,390,000 ng.ml-1) was recognized with a high level of CK (63,500 IU.l-1). Body temperature was 37.6 degrees C, and electrocardiogram and serum potassium were within normal ranges. After the diuresis with mannitol and furosemide, the urine became clear. On the 4th postoperative day, he was discharged without any complication. This case suggested that rhabdomyolysis can develop after sevoflurane anesthesia in patients with DMD.

The differences in hemodynamic effects of amrinone, milrinone and olprinone were evaluated in 46 patients for valvular cardiac surgery after cardiopulmonary bypass (CPB). Patients were randomly allocated to three groups; group A with amrinone infusion (17 patients); group M with milrinone infusion (15 patients); and group O with olprinone infusion (14 patients). Each drug was administrated as a single dose into the venous reservoir of the CPB circuit 15 min prior to the end of emergence from CPB, followed by continuous infusion. Hemodynamic parameters were measured at the time of preCPB (C0), just after the end of CPB (C1), one hour after the termination of CPB (C2) and after the chest closure (C3). Catecholamines were used in order of dopamine, norepinephrine and dobutamine. These doses were modulated to maintain the cardiac index > 3.0 l.min-1.m-2 by each anesthesiologist. Hemodynamic parameters (at C0, C1, C2 and C3) and the doses of cathecholamine (at C1, C2 and C3) were compared among the 3 drugs. The systolic blood pressure in group M was significantly higher than that of group A and group O after chest closure. In group M and A, the systolic blood pressure showed a significant increase after CPB. On the other hand, the systolic blood pressure showed no significant change in group O after CPB. Three drugs showed no significant difference in the dosages of catecholamines used.

The position of oxyhemoglobin dissociation curve (ODC) expressed with P50, has a large influence on the oxygen supply. It has been reported that during hypoxia with increased oxygen demand, P50 can increase with a reduction in oxygen affinity. In this study, we investigated the effect of preoperative factors on intraoperative P50 and the relation between the P50 values of the mixed venous blood and those of internal jugular bulb venous blood in seventy patients for cardiac surgery. Preoperative reduction in percentage vital capacity (%VC) and reduced hemoglobin concentration were associated significantly with an increase in intraoperative P50 value. The P50 act (P50 value with only temperature adjusted to 37 degrees C) of the internal jugular bulb venous blood was significantly higher than that of mixed venous blood. These results suggest that intraoperative tolerance to hypoxia and the increase in oxygen demand might be reduced in patients with preoperative abnormality of %VC and the hemoglobin concentration. And this tolerance might be limited in brain.

Cardiac output is measured by pulse dye-densitometry using indocyanine-green (ICG). This cardiac output is estimated by correlating with the cardiac output measured by pulmonary artery catheter using thermodilution method. Twenty-four patients scheduled for elective cardiovascular surgeries under general anesthesia were studied. The pulse dye-densitometry monitoring system used was DDG-2001 (Nihon Kohden, Japan). In group A (13 patients: 19 times), ICG was administered from the peripheral vein as bolus doses of 5, 10 or 20 mg (5 mg.ml-1 water solution). In group B (11 patients: 12 times), ICG was administered from the peripheral vein as bolus doses of 20, 10 or 5 mg (5 mg.ml-1 water solution). The correlation (Pearson's correlation coefficient) and precision (the method proposed by Bland and Altman) compared with cardiac output measured by pulmonary artery catheter were examined. Better correlation and precision were recognized after 20 mg ICG injection than 5 or 10 mg ICG injection. In conclusion, the measurement of cardiac output by pulse dye-densitometry with peripheral vein ICG injection was useful using a bolus dose of ICG 20 mg.

In 1994, Barnes found the new method "long PCR method" where over 10 kb DNA was easily amplified, compared with conventional PCR method in which only a few kb DNA was amplified. He devised the new enzyme in this system which included Taq DNA polymerase plus a little amount of 3'-->5' exonuclease activity (proofreading activity). We tried to apply this method to detect mitochondrial DNA deletions in mitochondrial encephalomyopathies. We detected mtDNA deletions easily, however, we could not quantify mtDNA deletions. This method can be performed within one day, compared with about 1 week required to perform Southern blotting and/or several sets of conventional PCR. Although Southern blotting is needed for quantifying mtDNA deletions, this method will become a useful screening method for detecting mtDNA deletions.

We evaluated the effects of amrinone on oxygen demand-supply relationship after cardiopulmonary bypass (CPB) in patient undergoing coronary bypass surgery comparing with the patients not receiving amrinone. In amrinone treated patients bolus dose of amrinone 1.5 mg.kg-1 was administrated into the reservoir of CPB and followed by continuous infusion at a rate of 5 micrograms.kg-1.min-1. Hemodynamics and blood gas (arterial and mixed venous) measurements were carried out immediately after CPB, 1 hour after CPB and after the chest closure. After the chest closure, cardiac index and oxygen supply in amrinone treated group were significantly higher and systemic vascular resistance was significantly lower than in non-treated group. Left ventricular stroke work index, rate pressure product and oxygen consumption showed no significant difference between the two groups. These data indicate that the amrinone treated patients preserved better oxygen demand-supply relationship after CPB compared with the non-treated patients undergoing coronary bypass surgery.

A 54-year-old woman with pheochromocytoma was anesthetized using magnesium sulfate infusion. Anesthesia was induced with thiopental and fentanyl, and maintained with 0.5% sevoflurane in nitrous oxide/oxygen and 60 mg.hr-1 of epidurally infused lidocaine. Muscle relaxation was achieved with intermittent administration of vecuronium under neuromuscular monitoring. Magnesium 2 g was infused prior to the tracheal intubation and followed by continuous infusion of 2 g.hr-1. These anesthetic techniques made hemodynamic state stable, and no additional vasoactive agents were needed. However, the infusion rate of magnesium was reduced to a half because of PQ interval prolongation. Magnesium is believed to be useful for anesthetic management for patients with pheochromocytoma, but the proper dose and the way of administration should be further investigated for their safe clinical use.

The mutation underlying myotonic dystrophy is the expansion of polymorphic CTG repeat in the 3'-noncoding region of the myotonin protein kinase (MtPK) gene mapping to chromosome 19q13.3. A full-length cDNA of human MtPK was cloned and expressed in COS-1 cells. MtPK is recovered from the COS cell extract as a 70 kDa protein, which coincides with the size deduced from the predicted amino acid sequence. Biochemical characteristics of MtPK expressed in COS cells and its expression are investigated.

We have analyzed therapeutic effects of selective radicular block for 30 patients of reflex sympathetic dystrophy with residual intractable pain after neurolytic sympathetic ganglion blockade. Ten patients showed complete pain relief after the therapy with a effective rate of 66.7%. Minor side effects were observed in 3 cases (10%). When examined 2 month after the therapy, the effect had persisted in 16 cases in successful 20 cases. The therapy could not relieve complaints induced by numbness and neuroma. By the therapy, patients with diffuse pain were more comfortable than patients with regional pain. In indicated cases, this therapy is useful for residual complain of reflex sympathetic dystrophy after neurolytic sympathetic ganglion block.

We reported the first case of angiotropic lymphoma diagnosed by adrenal biopsy in Japan. Immunohistochemical study and southern blot hybridization analysis proved it to be B-lymphocyte origin. A 61-year-old man with history of mild hypertension and diabetes mellitus was admitted to our department because of recurrent minor stroke. On admission, general physical findings were normal. Laboratory investigations showed an elevated erythrocyte sedimentation rate and increased serum lactic dehydrogenase (LDH) level. The serial computed tomographic (CT) scan of the brain showed multifocal abnormal density lesions in bilateral hemispheres. Magnetic resonance imaging (MRI) of the brain demonstrated multiple lesions of increased signal intensity in the brainstem and bilateral hemispheres. A subsequent CT scan of the abdomen revealed swelling of bilateral adrenal glands. Adrenal biopsy was performed. Biopsy samples showed the intravascular proliferation of malignant lymphoma cells, non-Hodgkin, diffuse large cell type. These cells had the immunophenotype of a B cell lymphoma (reactive with the antileukocyte common antigen, anti-MB-1, anti-MB-2 and anti-MX-pan B, and unreactive with the anti-MT-1, anti-UCHL, anti-Ki, anti-kappa, anti-lambda and antifactor-VIII). Southern blot hybridization analysis showed monoclonal rearrangements of the immunoglobulin heavy-chain gene, which strongly suggested a B-lymphocyte origin. Thus, a diagnosis of angiotropic lymphoma was made. As soon as chemotherapy was begun, the patient fell into deep coma. A repeat CT scan of the brain was normal. His clinical status gradually deteriorated, and he died 18 months after his initial symptom. Autopsy, which was limited to the body, revealed characteristic systemic intravascular stagnation of lymphoma cells.(ABSTRACT TRUNCATED AT 250 WORDS)

The efficacy of methylprednisolone (MP) (500 or 250 mg) or droperidol 2.5 mg administered i.v., was studied in 200 women undergoing major gynaecological surgery. Following a standardised general anaesthesia technique with intrathecal morphine, the incidence of nausea and vomiting was assessed. The frequency of postoperative nausea and vomiting in the non-treated group was 59% and 35%; the group of MP 500 mg has a significant reduction of nausea and vomiting to 21% and 13%. Droperidol 2.5 mg decreased the incidence of postoperative nausea alone (nausea: 36%, vomiting: 19%). MP 250 mg was not effective in reducing either nausea or vomiting (nausea: 44%, vomiting: 38%). It was concluded that, of the drugs studied, MP 500 mg was most effective in preventing nausea and vomiting after major gynaecological surgery.

Sequential in vitro lymphocyte function tests in 13 patients undergoing cardiac operation were performed to study B lymphocyte function following operation. Lymphocytes were stimulated with phytohemagglutinin (PHA), pokeweed mitogen (PWM) and Staphylococcus aureus Cowan 1 (SAC). Mitogen responses were measured by 3H-labeled thymidine incorporation. The SAC responses were significantly depressed following operation. Immunoglobulin secreting cells were measured by protein A plaque forming cell assay. The numbers of immunoglobulin secreting cells induced by PWM or SAC decreased remarkably at least as long as 3 day after the operation. The percentage of circulating B lymphocytes increased significantly postoperatively. This indicates that the B lymphocytes remaining after the operation were functionally impaired.

Protein A isolated from Staphylococcus aureus can bind the Fc portion of IgG of several species. We used Protein A coupled to Sepharose CL-4B (Protein A-S) for the separation of antibody-bound and free radiolabeled hCG in the radioimmunoassay, and the results were compared to the double antibody method. One gram of Protein A-S containing 7 mg of Protein A was dissolved in 17.5 ml of 1/15M phosphate buffer saline pH 7.4. Two hundred fifty microliters of this suspension were added to the assay tubes 24 hours after mixing 125I-hCG, anti-hCG and hCG standards or serum samples. After further incubation for 10 minutes at room temperature, the tubes were centrifuged and the radioactivity in the precipitates was measured by a gamma spectrometer. The standard curve obtained by the Protein A-S method was virtually identical to that obtained using the double antibody method. The intra- and interassay coefficients of variation in the hCG radioimmunoassay using the Protein A-S method ranged from 6.6 to 8.2% and from 7.2 to 11.9% respectively, which were close to those obtained by the double antibody method. IgG in serum inhibited the binding of Protein A-S to anti-hCG, and thus it was necessary to dilute the samples more than one-hundred fold. Under these conditions a good correlation exists in the serum hCG levels determined by either the Protein A-S method or the double antibody method. Thus, Protein A-S permitted the rapid separation of antibody-bound and free radiolabeled hCG in the radioimmunoassay and could be substituted for the second antibody.