Summary A 3‐month‐old boy with retractive breathing from his birth was scheduled for a rigid bronchoscopic examination. Anesthesia was induced and maintained with sevoflurane. The examination revealed a slight laryngomalacia which was not compatible with his severe symptom. During the procedure, no respiratory deterioration occurred. He was once extubated in the operating room, however, developed severe desaturation immediately. He was reintubated at the scene and returned to the ward being mechanically ventilated and sedated. The next day, his respiratory condition worsened gradually. Conventional drugs including theophylline, corticosteroid and beta adrenergic agonist did not improve his deleterious condition. He became bradycardic and was on the verge of circulatory collapse as his lungs were unable to ventilate. Then, we commenced inhalation of sevoflurane using a standard anesthesia machine, which relieved him from ventilatory crisis. Although there were some difficulties in using anesthesia machine in the ICU, we could successfully manage mechanical ventilation. After the beginning of sevoflurane inhalation, his condition improved gradually. Discontinuation of sevoflurane was difficult and it took 94 h to wean from sevoflurane inhalation. Despite long duration of inhalation, no adverse effects of sevoflurane were observed except transient mild increase in liver transaminase. There have been very few reports on application of sevoflurane inhalation for such a long period in infants with bronchospasm. Moreover, measured serum fluoride concentration (24.2 μmol·l −1 ) during inhalation was well below harmful level. Sevoflurane inhalation is worth attempting and safe to treat life‐threatening bronchospasm even in infants.
Twenty patients with relapsing myeloma were treated with combination chemotherapy of ranimustine, doxorubicine, and dexamethasone (RAD) between July 1996 and March 2000. Of the 19 evaluable patients, 5 (26.3%) achieved partial response after the first round of RAD therapy and 10 (52.6%) achieved partial response after the second round of RAD therapy. Of 10 evaluable patients who had previously received high-dose dexamethasone therapy including VAD therapy, 2 (20%) achieved partial response after the first round of RAD therapy and 3 (30%) achieved partial response after the second round of RAD therapy. The median survival was 10.5 months and the progression-free survival was 9.3 months. Patients who responded to RAD therapy had a survival rate at 43 months of 59.3%. Toxicity and adverse events during RAD therapy were tolerable. This pilot study demonstrated that RAD therapy is useful for the treatment o frefractory myeloma.
A 40-year-old man was diagnosed with Langerhans cell histiocytosis (LCH) in October 2010. His LCH was refractory to conventional chemotherapy, and thus worsened to Langerhans cell sarcoma (LCS) in May 2011. Although we repeated combination chemotherapies, new infiltration of the liver and bone marrow, as well as primary lesions of the bone, lymph nodes, and skin, appeared. These intensive chemotherapies caused candida liver abscesses, invasive aspergillosis, disseminated varicella zoster virus infection and bacterial sepsis. We administered bendamustine for chemotherapy, which resulted in a partial response (PR) with no severe adverse events. Because of pancytopenia caused by secondary myelodysplastic syndrome, we stopped the bendamustine chemotherapy after two courses. PR was maintained for 4 months. We plan to perform allogeneic hematopoietic stem cell transplantation from a sibling donor after a conditioning regimen. Optimal therapy for adult LCH, which is a rare and treatment-resistant disease, has yet to be established. Bendamustine is a potential chemotherapeutic agent for standard treatment of LCS.
Using H-7, HA1001, FK506, cyclosporin A (CsA) and okadaic acid (OA), which are protein kinase and phosphatase inhibitors, we examined qualitative changes in hematopoietic precursor cells due to aging from the viewpoint of the role of protein kinases and phosphatases. Though H-7 and OA suppressed erythroid colony formation both in the elderly (age: 72-92, median: 86) and the young (age: 22-39, median: 29), no change due to aging was noted. HA1001 did not affect erythroid colony formation either in the elderly or the young. Erythroid colony formation was enhanced by FK506 and CsA in the young, however, erythroid colony formation was suppressed in the elderly. Similar examinations using cell fractions of non-T, non-macrophage, non-T + T, and CD34 positive cells were performed in both groups. Enhancement of erythroid colony formation in the young and suppression in the elderly by FK506 using unseparated MNC disappeared after removal of T cells. Enhancement of colony formation in the young and suppression of colony formation in the elderly were recovered when T cells were added again. The effects of FK506 and CsA on erythroid colony formation were thought to be the results of T cell inactivation, and the different sensitivity to FK506 and CsA in the elderly and young seemed to be the result of changes in the control mechanisms of hematopoiesis, such as the regulation of cytokine production by T cells, caused by aging.
