[CPT-11 chemotherapy for a hemodialysis patient with small-cell lung cancer].

We report a hemodialysis patient with extensive small-cell lung cancer who was administered CPT-11(50mg/m2)chemotherapy and achieved a partial response after four courses of chemotherapy. Hemodialysis was performed 24 hours after the first course of CPT-11 was completed. Because the patient developed thrombocytopenia and pneumonia, hemodialysis was performed 4 hours following the second course of chemotherapy, after which grade III bone marrow suppression was observed. The plasma concentrations of CPT-11 and its metabolic products(SN-38 and SN-38G)were measured during both courses. A pharmacokinetic study showed that the plasma concentration of CPT-11 after the first course was relatively high, and that the kinetics was similar to that in a non-dialysis case. However, 4 hours after hemodialysis, the concentrations of CPT-11 and SN-38G were re-elevated, and showed a sustained level higher than that obtained 24 hours after hemodialysis. Further study is needed to determine the optimal dosages of CPT-11, and the best time to conduct hemodialysis for chronic cancer patients requiring it.

Physical features of pediatric patients with lumbar spondylolysis and effectiveness of rehabilitation.

The purpose of this study was to evaluate the physical features of pediatric patients with lumbar spondylolysis (LS), factors that increase the load during compensatory movements at the lumbar spine, and the outcomes of rehabilitation. Twenty patients were included. Fifteen items were used:fingertip-to-floor distance (FFD), straight leg raising (SLR), heel-to-buttock distance (HBD), tightness of the rectus femoris, the lateral and medial rotator muscles, iliopsoas, tensor fascia lata, adductor muscles, soleus muscle, and latissimus dorsi, and trunk rotation, sit-ups and endurance of the abdominal and back muscles. Initial findings were judged as positive or negative using previously reported cut-off values and were re-evaluated 2 or 3 months later. Positive tests were found for HBD and tightness of the rectus femoris in 85% of the patients, for endurance of the abdominal muscles in 75%, SLR and sit-ups in 70%, and FFD and tightness of the external rotator muscles in 60%. The physical features varied according to the type of sport played, and some patients were refractory to rehabilitation. Only 17.6%, 33.3%, and 40.0% of patients with initially positive findings for HBD, tightness of the external rotator muscles, and endurance of the abdominal muscles, respectively, achieved improvements after rehabilitation. J. Med. Invest. 65:177-183, August, 2018.

[Successful control of rapid heart rate in a patient with atrial fibrillation by continuous intravenous administration of landiolol hydrochloride].

A 79-year-old man with atrial fibrillation underwent total pharyngolaryngectomy and free flap reconstruction for hypolaryngeal cancer under general anesthesia. He developed tachyarrhythmia with ST depression and inverted T wave. The treatment including sufficient fluid therapy, continuous administration of vasodilator and intravenous digoxin failed to control the abnormalities. Then landiolol hydrochloride, a new cardioselective ultra-short acting beta-blocker, was continuously administered. Despite the relatively low doses with 1 min loading infusion at 0.04 mg.kg-1.min-1 and continuous infusion at 0.016 mg.kg1.min-1, rapid control of heart rate occurred in a few minutes and inverted T waves were normalized in fifteen minutes. There was no significant change of peripheral blood pressure. The present case suggests that landiolol hydrochloride is effective in controlling heart rate in a patient with atrial fibrillation and that the optimal dose should be carefully evaluated for each case.