Two cases of advanced colorectal cancer which demonstrated the reversibility of oxaliplatin-mediated increase in splenic volume

Hepatic sinusoidal injury arises occasionally after oxaliplatin-based chemotherapy. As a result, portal hypertension associated with splenomegaly occurs in some cases. We report two cases of advanced colorectal cancer which showed splenomegaly after administration of oxaliplatin-based chemotherapy. In both cases, mFOLFOX6/bevacizumab was administered as a firstline chemotherapy. Splenic volume was determined by loading the CT images onto a commercially available workstation. In case 1, initial splenic volume was 137.82mL. Two months later, it increased to 160.96mL. After six cycles of chemotherapy, we removed oxaliplatin due to peripheral neuropathy. Consequently, the splenic volume decreased to 151.58mL. Subsequent to the reintroduction of oxaliplatin, the splenic volume increased to 177.48mL. Following two cycles of mFOLFOX6/bevacizumab, oxaliplatin was removed again. In a similar way, splenic volume decreased to 158.52mL. In case 2, initial splenic volume was 105.84mL. Ten months later, it increased to 228.54mL. After administration of mFOLFOX6/bevacizumab, we continued chemotherapy with sLV5FU2/bevacizumab and irinotecan. The splenic volume decreased to 197. 06mL. In conclusion, oxaliplatin- based chemotherapy induces an increase in splenic volume, however, it may be reversible after discontinuation of oxaliplatin.     

Studies of monkey complement: measurement of cynomolgus monkey CH50, ACH50, C4, C2 and C3

Abstract: Background: The cynomolgus monkey is commonly used as the recipient in transplantation experiments. However, study of the complement system of cynomolgus monkeys is lacking. In the present study, the complement system of cynomolgus monkeys was compared with that of humans, by checking hemolytic titers. Methods: Hemolytic titers of complement from cynomolgus monkeys were calculated using the same methods as are used in humans. The complement regulatory function of human decay accelerating factor (DAF, CD55) in cynomolgus monkey serum was next studied using erythrocytes from human DAF‐transgenic pigs. Results: The results indicated relatively high values, except for C4: CH50: 211.19 ± 42.78 units/ml, ACH50: 51.47 ± 12.43 units/ml, C4: 30 170 ± 14 300 SFU/ml C2: 33831 ± 7442 SFU/ml and C3: 93612 ± 30131 SFU/ml. Western blot experiments using antibodies for human complement components revealed similarities between the cynomolgus monkey and human complement systems. Human DAF inhibited pig erythrocyte lysis from approximately 60–70% to 17% in both human and cynomolgus monkey sera, indicating an almost identical complement regulatory function. Conclusion: The hemolytic titer of cynomolgus monkeys was greater than the titer measured in human serum. However, human DAF showed nearly the same complement regulatory function in both human and cynomolgus monkey sera.     

A pitfall of AirWay Scope--an experience of distinctive airway edema after palatal laceration caused by irWay Scope

Pentax AirWay Scope (AWS) is a new videolaryngoscope which allows indirect visualization of the vocal cords and provides a better laryngeal view compared with the conventional Macintosh laryngoscope. We report a female patient who developed distinctive upper airway edema after palatal laceration at the time of insertion of the AWS. She was scheduled for tympanoplasty. After anesthesia induction, there was technical difficulties in tracheal intubation with Macintosh laryngoscope (her Cormack grade was rated as 3), and we used the AWS, but could not obtain an appropriate view on the monitor. When the device was removed, we detected bleeding derived from the right palatal laceration. Following the aspiration of the blood, we could barely achieve tracheal intubation with a flexible fiberscope without hypoxemic episode. The upper airway including the arytenoid and vocal cords were distinctively edematous after the operation. Then, the tracheal tube was left for three days after the operation, to secure the airway until the reduction of airway edema. On the postoperative day 4, following the fibroscopic confirmation that the airway edema was reduced, the patient was extubated successfully. AWS should be used more carefully, especially at the time of insertion along the palate.     

Wastage of anesthetic related drugs in a university hospital

BACKGROUND: The cost of wasted anesthetic related agents has not been clear in Japanese hospitals. We investigated whether the trainees in anesthesiology influence the cost of wasted anesthetic related agents. METHODS: Investigation was carried out at the University of Tokyo Hospital. We interviewed each trainee in anesthesiology about all prepared anesthetic drugs and wasted ones at the end of each anesthetic management. RESULTS: The percentage of wasted ampoules of anesthetic related agents was 15.85%, but the percentage of wasted cost was 5.15%. A large difference was not observed in transition of training period, and this percentage was not improved by training. We considered that this wasted cost is within permissible ranges in comparison with other reports. CONCLUSIONS: During the training it is also important to develop a sense of medical economics.     

Therapeutic Effects of Benzoxazinorifamycin KRM-1648 Administered Alone or in Combination with a Half-Sized Secretory Leukocyte Protease Inhibitor or the Nonsteroidal Anti-Inflammatory Drug Diclofenac Sodium against Mycobacterium avium Complex Infection in Mice

The effects of half-sized secretory leukocyte protease inhibitor or diclofenac sodium administered alone or in combination with the benzoxazinorifamycin KRM-1648 on the therapeutic efficacy of KRM-1648 against Mycobacterium avium complex (MAC) in mice were studied. Neither of the two anti-inflammatory drugs affected the efficacy of KRM-1648, while they exerted significant modulating effects on tumor necrosis factor alpha production by MAC-infected macrophages.     

Hydrothorax: an unexpected complication after laparoscopic myomectomy

We report a case of hydrothorax as a complication of laparoscopicmyomectomy in an otherwise healthy woman. The most likely causeof the patient’s hydrothorax was irrigation fluid movingfrom the peritoneal cavity into the pleural space via defectsin the diaphragm. Anaesthestists and surgeons should considerhydrothorax as a potential complication in any patient undergoinglaparoscopy. Br J Anaesth 2001; 87: 507–9     

Lymph node metastasis within the pectoralis major muscle in breast cancer--a case report

We report herein, a case of a 75 year old woman with breast cancer in whom lymph node metastasis within the pectoralis major muscle was found. The breast mass measured 10 X 6 cm, and its overlying skin was red and edematous, suggesting inflammatory carcinoma. An extended radical mastectomy was performed and the lesion was histologically confirmed to be solid-tubular carcinoma with regional lymph node involvement. In the pectoralis major muscle, where lymph nodes do not usually exist, one positive metastatic lymph node and another metastatic lymph node-like nodule were histopathologically confirmed. To our knowledge, no other such case has ever been reported, yet the possibility of lymph nodes existing in the pectoralis major muscle, albeit rare, should nevertheless be considered in the treatment of breast cancer.