Drip Infusion Research Articles

A Case of Acute Myocardial Infarction during Chemotherapy of Advanced Rectal Cancer

Background:Cetuximab and irinotecan, levoforinate, 5-FU (FOLFIRI) are administered to advanced colorectal cancer. Although this regimen is standardized for recurrent metastatic colorectal cancer, the merger of myocardial infarction is rare.Purpose:The aim of this study is consider factors of myocardial infarction that developed during chemotherapy of colorectal cancer.Method:We conduct a retrospective study of cases in which myocardial infarction develops during chemotherapy in colorectal cancer on the basis of medical records, nursing records and physiological function test results.Case:A 80-year-old man was in chemotherapy with cetuximab + FOLFIRI in outpatient with multiple lung metastasis diagnosis after rectal cancer surgery.Result:Three days after the 38th administration, the patient visited an emergency outpatient mainly with complaints of dyspnea and back pain. Electrocardiogram was a finding that the lower wall infarction is suspected. The patient of bi-aspirin oral administration and chest pain 10 mg of morphine hydrochloride was injected via intravenous drip infusion, and it was transferred to a specialized cardiovascular hospital.Emergency coronary angiography was performed in the diagnosis of acute myocardial infarction, and percutaneous coronary intervention was performed because the left anterior descending branch complete occlusion was recognized. After thrombus aspiration, the balloon was dilated, the stent was placed, and reperfusion was successfully completed. The patient was discharged on the 10th disease day.In this case, it is thought that cetuximab + FOLFIRI synergistically induced hyperthrombogenicity, coronary plaque erosion, and acute myocardial infarction.It may also be necessary for interventions such as monitoring of risks in daily living by the medical care provider and guidance on risk avoidance behaviors.brief background of the topic and significance of the study.Conclusion:In this case, it is thought that cetuximab + FOLFIRI synergistically induced hyperthrombogenicity, coronary plaque erosion, and acute myocardial infarction. It may also be necessary for interventions such as monitoring of risks in daily living by the medical care provider and guidance on risk avoidance behaviors.

Rationale and Design of a Phase II Trial of Osimertinib Combined With Bevacizumab in Patients With Untreated Epidermal Growth Factor Receptor-mutated Non–small-cell Lung Cancer and Malignant Pleural and/or Pericardial Effusion (SPIRAL II Study)

Progression-free survival (PFS) of patients with non–small-cell lung cancer with pleural or pericardial effusion is expected to be prolonged with combination use of an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor plus bevacizumab compared with that with an EGFR-tyrosine kinase inhibitor alone. Phase I clinical trial data have been reported for combined treatment with osimertinib plus bevacizumab and demonstrated their safety, but the efficacy remains unclear, particularly in patients with pleural or pericardial effusion. This is an ongoing single arm, prospective, open-label, multicenter, phase II trial to evaluate the efficacy and safety of osimertinib plus bevacizumab combination therapy in EGFR mutation-positive patients with untreated or recurrent non–small-cell lung cancer and pleural and/or pericardial effusion. Osimertinib will be administered orally once daily at a dose of 80 mg. One cycle consists of 21 days. Bevacizumab 15 mg/kg will be administered by drip infusion on Day 1 of each cycle. Treatment will be continued until progressive disease or any of the discontinuation criteria are met. The primary endpoint will be the 1-year PFS rate. Secondary endpoints are response rate, PFS, overall survival, survival not requiring pleural/pericardial drainage, and safety. Osimertinib plus bevacizumab combination therapy is expected to prolong PFS and reduce adverse events. Trial registration numberUMIN000028071

The Accumulation and Effects of Liposomal Doxorubicin in Tissues Treated by Radiofrequency Ablation and Irreversible Electroporation in Liver: In Vivo Experimental Study on Porcine Models.

To compare the accumulation and effect of liposomal doxorubicin in liver tissue treated by radiofrequency ablation (RFA) and irreversible electroporation (IRE) in in vivo porcine models. Sixteen RFA and 16 IRE procedures were performed in healthy liver of two groups of three pigs. Multi-tined RFA parameters included: 100W, target temperature 105°C for 7min. 100 IRE pulses were delivered using two monopolar electrodes at 2250V, 1Hz, for 100 µsec. For each group, two pigs received 50mg liposomal doxorubicin (0.5mg/kg) as a drip infusion during ablation procedure, with one pig serving as control. Samples were harvested from the central and peripheral zones of the ablation at 24 and 72h. Immunohistochemical analysis to evaluate the degree of cellular stress, DNA damage, and degree of apoptosis was performed. These and the ablation sizes were compared. Doxorubicin concentrations were also analyzed using fluorescence photometry of homogenized tissue. RFA treatment zones created with concomitant administration of doxorubicin at 24h were significantly larger than controls (2.5 ± 0.3cm vs. 2.2 ± 0.2cm; p = 0.04). By contrast, IRE treatment zones were negatively influenced by chemotherapy (2.2 ± 0.4cm vs. 2.6 ± 0.4cm; p = 0.05). At 24h, doxorubicin concentrations in peripheral and central zones of RFA were significantly increased in comparison with untreated parenchyma (0.431 ± 0.078µg/g and 0.314 ± 0.055µg/g vs. 0.18 ± 0.012µg/g; p < 0.05). Doxorubicin concentrations in IRE zones were not significantly different from untreated liver (0.191 ± 0.049µg/g and 0.210 ± 0.049µg/g vs. 0.18 ± 0.012µg/g). Whereas there is an increased accumulation of periprocedural doxorubicin and an associated increase in ablation zone following RFA, a contrary effect is noted with IRE. These discrepant findings suggest that different mechanisms and synergies will need to be considered in order to select optimal adjuvants for different classes of ablation devices.

Prophylaxis and Treatment Strategy for Endothelial Cell Damages after Hematopoietic Cell Transplantation in Children

Introduction Sinusoidal obstruction syndrome (hSOS) and thrombotic microangiopathy (TMA) are life-threatening complications caused by endothelial cell damage (ECD) associated with hematopoietic cell transplantation (HCT). Danaparoid sodium (DS) is a heparinoid comprising a mixture of low molecular weight glycosaminoglycans with anti-Xa and anti-IIa effects, which prevent fibrin formation. Recombinant thrombomodulin (rTM) comprises the active extracellular domain of thrombomodulin and inactivates coagulation by binding to thrombin. Both of them were expected to play crucial roles in the management of disseminated intravascular coagulation (DIC) and ECD after HCT. Objectives We aimed to evaluate the efficacy and feasibility of DS for prophylaxis and rTM for the treatment of hSOS and TMA after HCT in children. Methods Between January 2011 and December 2017, 91 children (median age 7.6 years, range 0.6–18.2; with hematologic malignancies [n = 54], solid tumors [n = 9], or benign diseases [n = 28]) underwent 118 consecutive HCTs (9 autologous and 109 allogeneic settings; busulfan-based myeloablative conditioning [n = 23], total body irradiation-based myeloablative conditioning [n = 35], or reduced intensity [n = 60]) at our institution. All of them were treated prophylactically with DS (intravenously injection, 30 international units [IU] per kg of body weight, twice a day from the initiation of the conditioning regimen to day 50 after HCT) to prevent ECD. Any patient who developed ECD despite prophylaxis were treated with rTM (intravenous drip infusion, 380 IU per kg, once a day). We reviewed their clinical records and evaluated the efficacy and feasibility of rTM for these children. Results Nine patients developed SOS (severe 5, moderate 1, and mild 3) at a median of 19 days after HCT (range, 6–173), and 6 patients developed TMA at median day 38 (range, 27–106). The cumulative incidences of SOS and TMA at 100 days were 6.8% and 4.4%, respectively. A total of 17 patients received 18 courses of rTM for complications after HCT. The median dose and duration of rTM treatments were 367 IU/kg/day (range, 189–404) and 7 days (range, 3–22), repectively. rTM treatments initiated at a median of 30 days after HCT (range, 6–173). The cause of rTM administration included SOS (n = 9), infection with DIC (n = 4), TMA (n = 3), or engraftment syndrome with DIC (n = 2). All these complications were resolved or improved by rTM treatment along with supportive care. Among the 17 patients receiving rTM treatment, no hemorrhagic events or deaths due to HCT-related toxicity were observed; however, 7 died of their underlying disease. Multivariate analysis revealed that neither SOS nor TMA had a negative impact for transplant outcome. Conclusion DS and rTM are effective and safe for the management of ECD after HCT in children. A larger multicenter prospective study is warranted to confirm these findings.

Liver regeneration therapy through the hepatic artery-infusion of cultured bone marrow cells in a canine liver fibrosis model.

BackgroundWe previously reported regenerative therapies for decompensated cirrhosis based on peripheral venous drip infusion using non-cultured whole bone marrow (BM) cells, or the less invasive cultured BM-derived mesenchymal stem cells (BMSCs). Here, we assessed the efficacy and safety of hepatic arterial infusion using cultured autologous BMSCs, comparing it with peripheral infusion, using our established canine liver fibrosis model.MethodsCanine BM cells were harvested and cultured, and the resultant BMSCs were returned to carbon tetrachloride (CCl4)-induced liver cirrhosis model canines via either a peripheral vein (Vein group) or hepatic artery (Artery group). A variety of assays were performed before and 4, 8, and 12 weeks after BMSC infusion, and liver fibrosis and indocyanine green (ICG) half-life (t1/2) were compared to those in a control group that received CCl4 but not BMSCs. The safety of this approach was evaluated by contrast-enhanced computed tomography (CT) and serial blood examinations after infusion.ResultsFour weeks after infusing BMSCs, a significant improvement was observed in the Vein group (n = 8) compared to outcome in the Control group (n = 10), along with a decrease in ICG t1/2. In the Artery group (n = 4), ICG t1/2 was significantly shorter than that in the Vein group at 8 weeks (Δt1/2: −3.8 ± 1.7 min vs. +0.4 ± 2.4 min; p < 0.01) and 12 weeks (Δt1/2: −4.2 ± 1.7 min vs. +0.4 ± 2.7 min; p < 0.01) after BMSC administration. Post-infusion contrast-enhanced CT showed no liver infarction, and blood tests showed no elevations in either serum lactate dehydrogenase concentrations or hypercoagulability.ConclusionsWe confirmed the efficacy and safety of the hepatic arterial infusion of cultured autologous BMSCs using a canine model, thereby providing non-clinical proof-of-concept.

A rare case of localized IgG4-related sclerosing cholecystitis mimicking gallbladder cancer.

Objective: IgG4-related sclerosing cholecystitis is generally associated with IgG4-related sclerosing cholangitis and presents with diffuse, circumferential thickening of the gallbladder wall. We report a rare case of localized IgG4-related sclerosing cholecystitis without IgG4-related sclerosing cholangitis, which was difficult to differentiate from gallbladder cancer preoperatively.Patient: A 56-year-old man with suspected IgG4-related disease or gallbladder cancer was admitted to our ward. The serum IgG4 level was elevated at 721 mg/dL. Computed tomography (CT) demonstrated focal wall thickening of the gallbladder fundus. Drip infusion cholecystocholangiography with CT revealed no dilation, stenosis, or border irregularity of the bile duct.Results: For diagnostic and treatment purposes, cholecystectomy with wedge resection of the gallbladder bed was performed. The pathological diagnosis was IgG4-related sclerosing cholecystitis.Conclusion: It is difficult to differentiate IgG4-related sclerosing cholecystitis from gallbladder cancer in cases involving localized thickening of the gallbladder wall. In similar cases, surgical resection with cancer in mind might be performed based on present clinical knowledge.

Impact of modified FOLFOX-6 for patients with gastric cancer and a gastrointestinal obstruction.

Gastric cancer patients are normally treated with oral fluoropyrimidine and cisplatin or oxaliplatin; however, treating patients who also have a gastrointestinal obstruction is often difficult because of their poor oral intake. Instead, a modified (m)FOLFOX-6 regimen is administered, even to patients with gastrointestinal obstructions. The aim of this study was to assess the efficacy of mFOLFOX-6 for gastric cancer patients with a gastrointestinal obstruction. Patients with a poor oral intake because of a gastrointestinal obstruction who received mFOLFOX-6 as systemic chemotherapy were retrospectively analyzed. Poor oral intake was defined as receiving a daily intravenous drip infusion due to a gastrointestinal obstruction. Eighteen patients received mFOLFOX-6; the median progression-free survival was 6.8 months (95% confidence interval [CI], 1.9-9.7), the median overall survival was 8.0 months (95% CI, 2.8-20.8) and the median time to treatment failure was 2.2 months (95% CI, 1.2-5.7). An improved oral intake was observed in 13 of the 18 treated patients, with 12 of these continuing treatment as outpatients. A mFOLFOX-6 treatment regimen seems promising for gastric cancer patients who have a gastrointestinal obstruction.

Evaluation of biliary anatomy in the caudate lobe using drip infusion cholangiography-computed tomography.

This study aimed to retrospectively evaluate the caudate branches (CBs), which are bile ducts originating from the caudate lobe (CL), using drip infusion cholangiography with computed tomography (DIC-CT). The confluence patterns of CBs were evaluated in 185 adult patients undergoing DIC-CT. The following bile duct features were evaluated: (a) number of depicted CBs; (b) identification of the caudate portion from which the CBs were derived; (c) identification of the confluence site of a CB; and (d) whether there was a difference in the confluence site of the CBs depending on the position of the right posterior hepatic duct (RPHD) and the portal vein (PV). DIC-CT enabled detection of a total of 640 bile ducts from the CL in 185 patients, and the total number of CBs from the Spiegel lobe (SP), the paracaval portion, and the caudate process (CP) were 347 (54.2%), 112 (17.5%), and 181 (28.2%), respectively. In the SP, over 60% of CBs joined the left hepatic duct system (LHDS). The positional relationship between the RPHD and the PV was divided into a supra-portal course (n = 168) and an infra-portal course (n = 17). The number of CBs joining the LHDS was significantly different between a supra-portal course and an infra-portal course (p = 0.0484). CBs were depicted by DIC-CT in 98.9% of the subjects, and a detailed evaluation was possible. The number of CBs joining the LHDS was associated with the position of the RPHD and the PV.

鈍的腎茎部損傷の治療法の変遷(Transition of treatment for blunt renal pedicle injury: through our 12 cases)

要旨鈍的腎茎部損傷（以下，本症）は，多発外傷を伴うことが多く，迅速な治療の選択を迫られる。しかし治療法が確立しているわけではない。自験例を検討し，本症の治療法を考える。沖縄県立中部病院の33年間と，沖縄県立北部病院の27年間に経験した12例に対して，診療録を後方視的に検討した。男女比は男9例，女3例。年齢中央値は31歳（9–58）。受傷機転は交通外傷10例，木材による圧挫傷1例，転落1例。多発外傷は5例で，他臓器損傷は全例に認めた。治療は腎摘6例，再建4例，未治療2例であった。再建腎の腎機能回復例は，1例のみであった。未治療の1例に高血圧を発症した。血液透析を要する症例はなかった。死亡例は2例で，原因は大量出血による凝固障害と敗血症であった。本症の治療では，救命が最優先であり，そのための腎摘や未治療は，許容される。再建群では不完全閉塞型腎動脈損傷の1例に術後腎機能が回復した。完全閉塞型に対する再建の成功率は非常に低いと考える。

Implementation of Intravenous Drip Infusion Therapy with Peripheral Venous Catheters and the Incidence of Related Complications in Home-Based Medical Care Settings in Japan

Background/Aims: Home-based medical care is rapidly expanding in Japanese health care settings. We aimed to clarify the implementation status of drip injection with peripheral venous catheters (PVCs) and the incidence of related complications. Methods: We investigated the number of patients who required intravenous drip infusion therapy at home. We also examined the incidence rate of PVC-related complications and their statistical correlation with patients’ characteristics. Results: Of 139 patients, 30 (21.6%) received intravenous drip infusion therapy through PVCs at home. Patients’ activities of daily living (bed-ridden) and the presence of underlying disease (terminal cancer) were significantly correlated with the requirement for drip infusion therapy (p < 0.0001 and p < 0.0001, respectively). A high incidence of PVC-related complications (75%: 15 out of 20 patients) was observed. More than 50% of patients experienced multiple needling due to difficulty in securing venous access. Conclusions: This is the first report to reveal the relatively high incidence of PVC-related complications in home-based medical care settings. Safer vascular devises should be incorporated for more stable intervention.

Excellent Outcomes of Large-Volume Epidural Blood Patch Using an Intravenous Catheter in 15 Consecutive Cases with Cerebrospinal Fluid Leak

The effects of large-volume epidural blood patch (EBP) remain unclear in patients with cerebrospinal fluid (CSF) leak. We report excellent outcomes from 15 consecutive CSF leak cases that underwent a large-volume EBP using an intravenous catheter from a single lumbar entry point, together with outcomes from 4 patients who underwent direct surgical closure or drip-and-rest therapy during the same period. Nineteen patients with idiopathic CSF leaks were enrolled in this study since November 2011 (12 women; mean age, 43.3 ± 14.0 years). Patient demographic data, radiologic findings, symptoms, administrated therapies, complications, and clinical courses were investigated retrospectively. Different types of headache were observed, including typical orthostatic headache alone (n= 10), orthostatic headache with chronic subdural hematoma (CSDH) (n= 3), and posture-unrelated headache accompanied with CSDH (n= 6). Regarding treatments, in 1 case, direct surgical closure was performed. In 15 cases, large-volume EBPs were performed, and the volume of injected blood was 44.8 ± 21.6 mL. The other 3 cases were treated by simple drip infusion regardless of the drainage for CSDH. Out of 9 cases with accompanied CSDH, recurrence of subdural hematoma was completely prevented by the application of an EBP after drainage in 5 cases and without drainage in 3 cases, and by simple intravenous drip-and-rest therapy after drainage in 1 case. Among 10 patients suffering from typical orthostatic headache alone, symptoms disappeared completely in 7 cases and were relieved in 3 cases. We demonstrate here a perfect control of spinal CSF leaks with the administration of a large-volume EBP through an intravenous catheter.

Internal biliary drainage for isolated posterior segmental biliary obstruction: a case report

BackgroundBiliary system anatomical abnormalities can be preoperatively detected on magnetic resonance imaging; therefore, some presume that the number of bile duct injuries should decline. However, once a bile duct injury occurs, repair may be difficult. There are various ways to repair bile duct injuries, but successful repair may be exceptionally difficult.Case presentationA 72-year-old Japanese man underwent a pancreaticoduodenectomy due to a diagnosis of middle bile duct cancer. We had a complication of an isolated posterior segmental biliary obstruction when pancreaticoduodenectomy was performed. We conducted a drip infusion cholecystocholangiography-computed tomography test to determine the positional relationship between his bile duct and elevated jejunum. To secure the bile duct we punctured the bile duct under computed tomography guidance, and the hepaticojejunal anastomosis site was visualized by inserting an endoscope. We vibrated the bile duct wall by inserting a guide wire through a puncture needle and verified the vibrations with the endoscope. We observed a partially compressed elevated jejunal wall upon guide wire insertion; therefore, we could verify a puncture needle penetration into the elevated jejunum by endoscope on insertion. We also successfully inserted an 8.5-Fr pigtail catheter into the elevated jejunum. We removed all drains after percutaneously inserting an uncovered metallic stent. Our patient’s subsequent clinical course was unremarkable. He visits our institution as an out-patient and has had no stent occlusion even after 6 months.ConclusionsWhen repairing bile duct injuries, it is important to accurately determine the positional relationships between the injured bile duct and the surrounding organs.

Adenosine, lidocaine, and Mg2+ (ALM) resuscitation fluid protects against experimental traumatic brain injury.

Currently, no drug therapy prevents secondary injury progression after traumatic brain injury (TBI). Our aim was to investigate the effects of small-volume intravenous adenosine, lidocaine, and Mg (ALM) resuscitation fluid after moderate TBI in a rat fluid-percussion injury model. Anesthetized, mechanically ventilated male Sprague-Dawley rats (449 ± 5 g) were randomly assigned to one of four groups: (1) sham (craniotomy without TBI), (2) no-treatment, (3) saline-control, or (4) ALM therapy groups (all n = 16). A subdural probe was implanted in eight animals per group to measure cerebral blood flow. Fifteen minutes after moderate TBI was induced with lateral fluid percussion injury (2.57 atm), a single 3% NaCl ± ALM bolus (0.7 mL/kg) was injected intravenously, and after 60 minutes (Phase 1), 0.9% NaCl ± ALM stabilization "drip" (0.5 mL/kg per hour) was administered for 3 hours (Phase 2). Mortality (without subdural brain probe) was 25% (saline controls) and 0% (ALM). Sixty minutes after bolus, ALM significantly increased cardiac function, cortical blood flow (CBF; approximately threefold) and blunted systemic inflammation compared to saline controls. Three hours after infusion drip, ALM improved left ventricular function, supported higher CBF, decreased proinflammatory cytokines systemically (IL-1β, tumor necrosis factor α, and regulated on activation, normal T cell expressed and secreted [RANTES]), increased anti-inflammatory cytokines in brain tissue (IL-10, IL-4), lowered brain injury markers (neuron-specific enolase, Syndecan-1, HMGB-1), reduced coagulopathy, increased platelet aggregation, and maintained baseline fibrinogen levels. Saline-controls were proinflammatory (brain, heart, lung, and blood) and hypocoagulable with neurogenic enlargement of the right side of the heart. Survival time significantly correlated with plasma neuron-specific enolase (p = 0.001) and CBF at 180 minutes (p = 0.009), and CBF correlated with brain anti-inflammatory cytokines (p = 0.001-0.034). After moderate TBI, ALM resuscitation fluid increased survival and protected against early secondary injury by reducing coagulopathy, inflammation, and platelet dysfunction.

EOC-110 - Investigation on Appropriate Drip Infusion Time of Peripheral Parental Nutrition Containing Amino Acids for Preventing Bacillus Cereus Bloodstream Infection

Background: Patients receiving peripheral parenteral nutrition containing amino acids are at higher risk of developing Bacillus cereus bloodstream infections, compared with those receiving other parenteral nutrition solutions. In some Japanese hospitals, patients using premixed infusion bags for parenteral nutrition developed a B. cereus bloodstream infection. This suggests that prolonged drip infusions (e.g., within 24 hours) might be one of the causes of B. cereus bloodstream infections. Therefore, this study aimed to determine the appropriate drip infusion time of peripheral parental nutrition containing amino acids for preventing B. cereus bloodstream infections.

Cutaneous mucormycosis caused by Mucor irregularis: a case report

A 39-year-old female patient presented with a painful plaque with ulcers on the right cheek for 2 months. She had acute myeloid leukemia for 1 year. After treatment, the patient achieved remission, but experienced recurrence half a year prior to the presentation. Skin examination showed a violaceous plaque measuring 5 cm × 5 cm in size on the right cheek with erosions and ulcers in the center, whose surface was covered with yellowish brown crusts. Granulation tissues were observed on the plaque, and yellow pus was exuded after the crusts were removed. The boundary of the plaque was sharp and slightly elevated, and there was obvious tenderness on palpation. Laboratory examination revealed increased white blood cell (WBC, 28.75 × 109/L) and lymphocyte counts (27.17 × 109/L) , but decreased neutrophil (1.05 × 109/L) and red blood cell counts (2.20 × 1012/L) , hemoglobin level (69 g/L) and platelet count (84 × 109/L) in the peripheral blood. The hepatic and renal function, electrolyte level and electrocardiogram were normal. Hematoxylin and eosin (HE) staining and periodic acid-Schiff staining of the lesion showed a large number of lymphocytes and histiocytes infiltrating in the dermis and broad aseptate hyphae. The fungal microculture yielded broad hyalinea septate hyphae, fungal rhizoids, stolons and spherical sporangia. The isolated fungus was identified as Mucor irregularis by using molecular biology techniques. The patient was diagnosed with primary cutaneous mucormycosis caused by Mucor irregularis complicated by acute myeloid leukemia. Then, the patient was treated with oral hydroxyurea at a dose of 0.5 g thrice a day, a single-dose intravenous infusion of 4 units of red blood cell suspension, and intravenous drip infusion of amphotericin B at an initial dose of 5 mg/d, which increased by 5 mg every day until 25 mg/d (about 0.5 mg·kg-1·d-1) . After the treatment, the lesion gradually became flat and smaller. After 12-day treatment, the patient was discharged because of a certain reason, and finally lost to follow-up. Key words: Mucormycosis; Leukemia, myeloid; Amphotericin B; Mucorirregularis

Acute Glaucoma Attack Following Microvascular Decompression Surgery for Trigeminal Neuralgia

Microvascular decompression (MVD) is widely accepted as an effective surgical method to treat trigeminal neuralgia (TN), but the risks of morbidity and mortality must be considered. We experienced a case of acute angle-closure glaucoma attack following MVD for TN in an elderly patient, considered to be caused by lateral positioning during and after the surgery. A 79-year-old female underwent MVD for right TN in the left lateral decubitus position, and TN disappeared after the surgery. Postoperatively, the patient tended to maintain the left lateral decubitus position to prevent wound contact with the pillow, even after ambulation. Two days after the surgery, she complained of persistent left ocular pain with visual disturbance. The left pupil was dilated with only light perception, and the intraocular pressure (IOP) was 44 mmHg. Acute angle-closure glaucoma attack was diagnosed. After drip infusion of mannitol, emergent laser iridotomy was performed. The corrected visual acuity recovered with normalization of IOP (14 mmHg). The subsequent clinical course was uneventful and she was discharged from our hospital. The left lateral positioning during and after the surgery was considered to have contributed to increase IOP of the eye on the dependent side, which resulted in acute angle-closure glaucoma attack. The potential pathology is difficult to assess preoperatively, but patient management should always consider the increased possibility of this condition with age.

Results of a Clinical Trial to Determine the Efficacy, Safety, and Tolerability of Intravenous Drip Infusion Therapy of a New Epoprostenol Formulation in Japanese Children with Pulmonary Arterial Hypertension

背景：小児肺動脈性肺高血圧症（PAH）患者に対するepoprostenolの新規持続静注製剤の有効性，安全性及び忍容性を検討する目的で治験を実施した．

2 Cases of Acute Confusional State with Autonomic Symptoms after Designer Tryptamine Abuse

We herein report 2 cases of acute tryptamine abuse. Both cases developed confusional state within 1 hour of 4- acetoxy-N-methyl-N-isopropyl-tryptamine ingestion. On admission, they presented confusion with marked mydriasis. In addition, one case showed hypertension, low grade fever, and hyperhidrosis, and the other showed the contraction of pilomotor muscles. Confusion and other autonomic symptoms improved gradually with intravenous drip infusion of saline. Tryptamine abuse should be considered as differential diagnosis in cases of acute confusional state with various autonomic symptoms.

Treatment results of the second-line chemotherapy regimen for patients with low-risk gestational trophoblastic neoplasia treated with 5-day methotrexate and 5-day etoposide.

ObjectiveHighly effective chemotherapy for patients with low-risk gestational trophoblastic neoplasia (GTN) is associated with almost a 100% cure rate. However, 20%–30% of patients treated with chemotherapy need to change their regimens due to severe adverse events (SAEs) or drug resistance. We examined the treatment outcomes of second-line chemotherapy for patients with low-risk GTN.MethodsBetween 1980 and 2015, 281 patients with low-risk GTN were treated. Of these 281 patients, 178 patients were primarily treated with 5-day intramuscular methotrexate (MTX; n=114) or 5-day drip infusion etoposide (ETP; n=64). We examined the remission rates, the drug change rates, and the outcomes of second-line chemotherapy.ResultsThe primary remission rates and drug resistant rates of 5-day ETP were significantly higher (p<0.001) and significantly lower (p=0.002) than those of 5-day MTX, respectively. Forty-seven patients (26.4%) required a change in their chemotherapy regimen due to the SAEs (n=16) and drug resistance (n=31), respectively. Of these 47 patients failed the first-line regimen, 39 patients (39/47, 82.9%) were re-treated with single-agent chemotherapy, and 35 patients (35/39, 89.7%) achieved remission. Four patients failed second-line, single-agent chemotherapy and eight patients (17.0%) who failed first-line regimens were treated with combined or multi-agent chemotherapy and achieved remission.ConclusionsPatients with low-risk GTN were usually treated with single-agent chemotherapy, while 20%–30% patients had to change their chemotherapy regimen due to SAEs or drug resistance. The second-line regimens of single-agent chemotherapy were effective; however, there were several patients who needed multiple agents and combined chemotherapy to achieve remission.

Fast-Response MoS2-Based Humidity Sensor Braced by SiO2 Microsphere Layers

In this letter, a MoS2-based humidity sensor braced by SiO2 microsphere layers with rapid response was developed. The results demonstrated that the humidity sensor can exhibit a subsecond response. A mechanism based on the morphology and structure of the sensing film was proposed to explain the rapid response behavior of humidity sensors. In addition, the effect of film thickness on response time was discussed. This letter demonstrated that the MoS2-based humidity sensor braced by SiO2 microspheres is suitable for the miniature drip infusion rate detection device.