[Case of fulminant idiopathic interstitial pneumonia treated by sodium siverlestat (Elaspol) and steroid pulse therapy following extracorporeal lung assist (ECLA)].

A patient with fulminant idiopathic interstitial pneumonia was treated by sodium siverlestat and steroid pulse therapy following extracorporeal lung assist (ECLA). On arriving at the emergency room, Pa(O2) was 44.5 mmHg under oxygen with 10 l reserver mask, and emergency intubation was performed. X-ray showed honeycomb lungs, and strong fine crackle was audible. Sodium siverlestat (14 days) and steroid pulse therapy (3 days) were started. P/F ratio was 187, but decreased to 56 the next day. After ECLA for 3 days, P/F ratio decreased to 248. On day 29, X-ray showed much improvement, and the patient was weaned from ventilator. But on day 33, the patient deteriorated. And treatment with sodium siverlestat (14 days) and steroid pulse therapy (3 days) was performed again. The patient was weaned from ventilator again on day 66. Steroid pulse therapy was not effective shown by KL-6 of over 2000 IU l(-1), but sodium siverlestat was effective. We consider that sodium siverlestat is effective for fulminant idiopathic interstitial pneumonia.

[Prophylactic use of droperidol for postoperative nausea and vomiting following gynecological laparoscopic surgery under total intravenous anesthesia].

BACKGROUND: Propofol and droperidol decrease the incidence of postoperative nausea and vomiting (PONV). We investigated the incidence of PONV after total intravenous anesthesia (TIVA) with propofol alone versus combined use of droperidol and propofol. METHODS: Eighty three patients, who had undergone laparoscopic gynecologic surgery with TIVA using propofol and fentanyl, were retrospectively evaluated whether droperidol had affected the incidence of early (up to six hours postoperatively) and late (6-24 hours postoperatively) PONV. Group D (46 patients) received droperidol intravenously at the end of surgery. Group N (37 patients) received no droperidol. RESULTS: The incidences of early nausea were 27% in Group N and 4% in Group D (P<0.01). The incidences of early vomiting were 0% in Group N and 8% in Group D. The incidences of late nausea were 14% in Group N and 13% in Group D. The incidences of late vomiting were 3% in Group N and 7% in Group D. CONCLUSIONS: Droperidol was useful in reducing the incidence of early nausea and vomiting after total intravenous anesthesia with propofol and fentanyl in the patients undergoing laparoscopic surgery.

[Postoperative intensive care of a patient with Cushing's syndrome accompanied with retroperitoneal abscess and massive subcutaneous emphysema].

A 60-year-old woman with Cushing's syndrome due to right adreno-cortical adenoma was referred to us because retroperitoneal abscess was found during surgical removal of the right adrenal gland. The diagnosis of Cushing's syndrome was made on the basis of elevated serum levels of cortisol. The abscess was accompanied with massive subcutaneous emphysema and pneumomediastinum. After operation the patient was admitted to ICU in the Medical Center for Emergency and Critical Care. PMX-DHP, continuous hemodiafiltration, and drainage were performed, and antibiotics were given. Nine days after the admission the patient recovered generally, and was transfferd to the Department of Urology. It was demonstrated that an opportunistic infection must be always considered in the condition like the present case.