[A case of ABO blood group incompatibility treated by exchange transfusion].

A patient with ABO blood group incompatibility who was treated by exchange transfusion is reported. A 63-year-old woman with blood group B type Rh (+) was accidentally transfused approximately 120 ml of A type Rh (+) packed red cells. She developed shock state, complaining chilliness, trepidation, nausea and vomiting just after the atypical blood transfusion. Fortunately, we could save her life without any complication by doing exchange transfusion in addition to anti-shock therapy and anticoagulant therapy preventing disseminated intravascular coagulation. The exchange transfusion was performed while monitoring central venous pressure. The total withdrawn blood reached 4300 ml, and 18 units of B type Rh (+) packed red cells, 10 units of AB type Rh (+) fresh frozen plasmas, 1250 ml of plasma protein fractions and 1750 ml of plasma expanders were infused with crystalloid fluid therapy. Although the amount of atypical blood transfusion to her was relatively small, it is considered that the exchange blood transfusion which seems to be only the fundamental therapy against atypical blood transfusion, took effect in saving her life without any complication.

Thoracoscopic en bloc total esophagectomy with radical mediastinal lymphadenectomy.

OBJECTIVE: Total esophagectomy with en bloc mediastinal lymphadenectomy for cancer carries a substantial morbidity and mortality rate. To investigate the feasibility of thoracoscopic technique, we carried out an extensive laboratory study. Encouraged by our excellent results, we conducted a clinical trial. METHODS: From September 1994 to September 1995, 39 patients thoracic esophageal cancer lesions not invading surrounding organs underwent total esophagectomy with mediastinal lymphadenectomy by means of thoracoscopy. Ages ranged from 47 to 86 years. The procedures were conventional except for the thoracic portion, which was performed as a thoracoscopic procedure with six trocar holes instead of thoracotomy. All harvested lymph nodes were counted for each station. Spirometric data and plethysmographically determined vital capacity were measured before and after operation for all patients. RESULTS: All procedures were accomplished as scheduled, and none was converted to open thoracotomy. The operating time was 200 +/- 41 minutes (mean +/- standard deviation). Estimated blood loss was 270 +/- 157 ml. The harvested lymph nodes numbered 19.7 +/- 11.1 per patient. Seventeen patients (45%) had positive lymph nodes. There were no in-hospital deaths within 30 days. Twenty-two patients did not require postoperative ventilatory support. Vital capacity decreased to 85% +/- 11% of the preoperative values, and forced expiratory volume in 1 second decreased to 82% +/- 16%. CONCLUSIONS: Thoracoscopic mediastinal lymphadenectomy is technically feasible, and its completeness is comparable to that of the open technique. The decline in pulmonary function is significantly less than that seen in our previous experience with the open technique.

[A co-operative study on prophylactic effect of oral administration of high-dose amphotericin B syrup for systemic fungal infection in patients with hematological neoplasms. Chugoku-Shikoku Study Group of Mycosis with Hematologic Disease].

The prophylactic effect of the oral administration of high-dose amphotericin B syrup for the systemic fungal infection was studied in 36 patients with hematological neoplasms. Twenty nine patients received 2,400 mg/day of Amphotericin B syrup for during the remission induction therapy. One patient received 1,200 mg/day, 3 received 800 mg/day and 3 received 400 mg/day of Amphotericin B syrup. The prophylactic effect was recognized in 24 of 36 patients, 66.7%. As adverse effects gastrointestinal symptoms such as nausea and vomiting, hypochloremia and hypopotassemia associated with hypochloremia was observed in one patient, respectively, however, they were all controllable. The blood levels of Amphotericin B in patients received 2,400 mg/day was 0.092 +/- 0.055 micrograms/ml (n = 40) on 7th day and 0.110 +/- 0.046 micrograms/ml (n = 21) on 28th day, respectively. The administration of high-dose of Amphotericin B syrup is expected not only for the prophylaxis but also for the treatment of the systemic fungal infection.

[Microangiopathic hemolytic anemia associated with gastric cancer].

A case of advanced gastric cancer associated with metastatic carcinomatosis of the bone marrow, microangiopathic hemolytic anemia (MAHA) and disseminated intravascular coagulation (DIC) was reported. A 71-year-old woman complained of lumbago and general fatigue. At the time of admission, besides anemia, jaundice and a tendency to bleeding, the laboratory data showed, hyperbilirubinemia, elevated FDP and hemolytic anemia with fragmented red cells. The bone marrow was infiltrated by carcinoma, and an upper GI series examination showed Borrmann II type gastric cancer on the greater curvature of the antrum. After remission of both MAHA and DIC by mitomycin C, neothramycin and FOY, the patient successfully underwent subtotal gastrectomy. However, she died of cerebral hemorrhage on the 96th postoperative day.

Postoperative cancer therapy for patients with carcinoma of the thoracic esophagus: an attempt of aggressive chemotherapy combined with proper nutritional support for patients with distant node metastasis.

The prognosis of patients with advanced thoracic esophageal carcinoma is still poor. In general, patients having distant lymph-node metastasis do not survive for more than 3 years. Therefore, a new therapeutic regimen employing aggressive chemotherapy for these patients has been attempted. In this regimen, three kinds of anticancer drugs Pepleomycin, and twice as much as Adriamycin and Mitomycin of the conventional level for a short period of time are used. Eleven cases were treated with this chemotherapy under active enteral and parenteral nutritional support of 45 to 50 kcal/kg daily. Two patients over 70 years of age died of pneumonitis. Four patients with recurrence of cancer in the lungs, liver and cervical nodes died after 10, 12, 13 and 14 months following surgery, respectively. Five patients have been alive for more than 2 years. These results indicate that this therapy is more effective than other conventional therapies. It has been shown that aggressive chemotherapy combined with proper nutritional support is effective for patients with node metastasis.