[Safe and Effective Analgesia with Bilateral Continuous TAP Block for a Patient with Marfan Syndrome after Open Abdominal Aortic Aneurysm Repair].

A patient with Marfan syndrome underwent emergency open abdominal aortic aneurysm repair. She was referred to our department for postoperative analgesia. Taking the risk of possible dural ectasia into consideration, we avoided epidural block. Alternatively, we performed bilateral continuous transversus abdominis plane (TAP) block with sufficient analgesia. Lumbosacral dural ectasia is frequently observed in patients with Marfan syndrome. A few reports described that their fragile dura may contribute to an increased risk of dural puncture and postdural puncture headache (PDPH). Thus, in planning neuraxial block for a patient with Marfan syndrome, the possible consequences of lumbosacral dural ectasia should be considered. A case we herein present shows bilateral continuous TAP block could be a safe and effective alternative to epidural block.

Effectiveness and safety of antiemetic aprepitant in Japanese patients receiving high-dose chemotherapy prior to autologous hematopoietic stem cell transplantation.

For patients receiving high-dose chemotherapy, a 5-hydroxytryptamine 3 receptor antagonist combined with dexamethasone is a standard antiemetic therapy. Despite this prophylactic anti-emetic treatment, many patients still suffer from uncontrollable emesis. In this study, we retrospectively evaluated the antiemetic effectiveness and safety of aprepitant (a neurokinin-1 receptor antagonist) in addition to 5-HT3 antagonist in Japanese patients with hematologic malignancy receiving high-dose chemotherapy prior to autologous peripheral blood stem cell transplantation (auto-PBSCT). Twenty-six patients received aprepitant and granisetron (the aprepitant group), whereas, 22 patients received granisetron alone (the control group). All patients received 3 mg of granisetron intravenously 30 min before chemotherapy administration. Patients in the aprepitant group additionally received 125 mg of aprepitant 60-90 min before administration of the first moderately to highly emetogenic chemotherapy. On the next day or thereafter, 80 mg of aprepitant was administered in the morning until the last administration of moderately to highly emetogenic anticancer drugs. The percentage of patients who achieved complete response (CR), defined as no emesis with only grade 1-2 nausea, in the aprepitant group was significantly higher than that in the control group (42% vs. 5%, p=0.003). Logistic regression analysis showed that non-prophylactic use of aprepitant was significantly associated with non-CR. The frequencies of adverse drug events (ADEs) were not significantly different between two groups. In conclusion, the results of this study suggest that the addition of aprepitant to granisetron can improve the antiemetic effect without increasing ADEs in patients receiving high-dose chemotherapy prior to auto-PBSCT.

Cardiac CT for intraseptal pseudoaneurysm: impending double rupture of ventricular septum and left ventricular free wall.

A 71-year-old woman presented at our hospital with chest discomfort. Cardiac CT showed an impending double rupture; an intraseptal pseudoaneurysm had ruptured into the right ventricle, while the left ventricular free wall remained intact at this stage. After admission, the patient fell into cardiogenic shock. Emergency surgery was performed. The intraoperative findings included a double rupture of the ventricular septum and the left ventricular free wall. Double rupture is a rare but fatal complication of myocardial infarction. Early diagnosis is essential. Recently, cardiac CT has emerged as a valuable tool for patients with possible ischaemic disease. In this case, enhanced cardiac CT showed an impending double rupture of junctional-type. The static and dynamic images of intraseptal pseudoaneurysm by two-dimensional (2-D) CT, 3-D CT and 4-D CT presented here provide insights into the mechanisms behind, and the pathophysiology of, double ruptures. They also demonstrate the significance of cardiac CT for evaluating ischaemic heart disease.

Inadequate spinal anesthesia in a patient with marfan syndrome and dural ectasia.

Lumbosacral dural ectasia is frequently observed in patients with Marfan syndrome. Although neuraxial anesthesia is often used in peripartum anesthetic management, few reports describe the effects of dural ectasia on the spread and duration of neuraxial anesthesia. We report a case of combined spinal-epidural anesthesia for a cesarean delivery in a patient with Marfan syndrome in whom complications probably related to dural ectasia occured.

Antiemetic effectiveness and safety of aprepitant in patients with hematologic malignancy receiving multiday chemotherapy.

PURPOSE: Antiemetic effectiveness and safety of aprepitant in patients with hematologic malignancy receiving multiday chemotherapy were evaluated. METHODS: All data were retrospectively collected from the Kyushu University Hospital's electronic medical record system. Patients age 20 years or older with hematologic malignancies who received multiday chemotherapy were included in the study. All patients received 3 mg of granisetron i.v. 30 minutes before chemotherapy administration. Patients in the aprepitant group received 125 mg of aprepitant orally 60-90 minutes before administration of the first moderately to highly emetogenic chemotherapy (day 1). On day 2 or thereafter, an 80-mg oral dose of aprepitant was administered in the morning for up to five days. The primary endpoint was the percentage of patients who achieved complete response (CR). RESULTS: A total of 42 patients were treated with aprepitant and granisetron as antiemetic prophylaxis between April and December 2010 (aprepitant group), and 40 patients were treated with only granisetron between March 1, 2009, and March 31, 2010, before the introduction of aprepitant. The percentage of patients who achieved CR in the aprepitant group was significantly higher than that in the control group (p = 0.01). Factors that were significantly associated with non-CR included the prophylactic use of aprepitant and chemotherapies containing ≥4 g/m(2)/day of cytarabine. The rates of adverse drug events (ADEs) did not significantly differ between groups. CONCLUSION: The addition of aprepitant to granisetron increased the antiemetic effect without influencing ADEs in patients treated with moderately to highly emetogenic multiday chemotherapy for hematologic malignancies.

Efficacy and safety of aprepitant in allogeneic hematopoietic stem cell transplantation.

STUDY OBJECTIVE: To evaluate the efficacy and safety of aprepitant added to standard antiemetic regimens used in high-dose chemotherapy for allogeneic hematopoietic stem cell transplantation (allo-HSCT). DESIGN: Retrospective medical record review. SETTING: Hematology ward of a university hospital in Japan. PATIENTS: Of 88 patients treated with high-dose chemotherapy followed by allo-HSCT, 46 received aprepitant and granisetron as antiemetic therapy (between April 1, 2010, and December 31, 2011), and 42 received granisetron alone (between April 1, 2008, and March 31, 2010). INTERVENTIONS: Patients in both groups received 3 mg of granisetron intravenously 30 minutes before the administration of anticancer drugs. In the aprepitant group, 125 mg of aprepitant was administered orally 60-90 minutes before the administration of the first moderately to highly emetogenic anticancer drug. On the following days, 80 mg of aprepitant was administered orally every morning. The mean administration duration of aprepitant was 3.3 days (range 3-6 days). MEASUREMENTS AND MAIN RESULTS: The primary objective was to evaluate the percentage of patients who achieved complete response (CR; no vomiting and none to mild nausea). The CR rate in the aprepitant group was significantly higher than that in the control group (48% vs 24%, p=0.02). Multivariate analysis showed that nonprophylactic use of aprepitant was associated with failure to achieve CR (odds ratio [OR] 2.92; 95% confidence interval [CI] 1.13-7.99, p=0.03). The frequency of abdominal pain was lower in the aprepitant group (9% vs 25%, p=0.03). Rates of other frequently observed adverse drug events were similar between groups. There was no significant difference in neutrophil engraftment (median 18 vs 17 days), platelet engraftment (median 32 vs 32 days), the incidence of acute graft-versus-host-disease (63% vs 55%, p=0.52), viral infection (74% vs 67%, p=0.49), or 1-year overall survival (63% vs 62%, p=0.90) between the two groups. CONCLUSIONS: The addition of aprepitant to granisetron increases the antiemetic effect without influencing transplantation-related toxicities in allo-HSCT.