Hirotoshi Iiboshi

Clinical application of ghrelin for chronic respiratory failure

Chronic respiratory failure, which is often caused by chronic obstructive pulmonary disease, chronic lower respiratory tract infection, or interstitial pneumonia, often leads to cachexia with disease progression. Patients who have chronic respiratory failure with cachexia exhibit increased morbidity. Although cachectic status is an important clinical problem, there are no effective therapies for cachexia. Ghrelin has various effects, including increasing food intake, attenuating sympathetic nerve activity, inhibiting inflammation, increasing cardiac output, and controlling fat utilization. These effects of ghrelin are ideal targets for the treatment of severely wasting chronic respiratory disease. In a few clinical studies, including a small randomized controlled trial, ghrelin administration to cachectic patients with chronic respiratory failure improved exercise tolerance, dyspnea, and appetite. The patients in these studies gained muscle mass and weight. In another study of chronic lower respiratory tract infection with cachexia, ghrelin suppressed airway inflammation by decreasing neutrophil accumulation in the airway, resulting in improvements in oxygenation and exercise tolerance. Although further clinical investigations are needed to clarify its usefulness, ghrelin is expected to become a novel therapy for cachectic patients with chronic respiratory failure.

Hepatic portal venous gas in a patient undergoing chemotherapy for non-small cell lung cancer

A 71-year-old man was diagnosed with c-stage IV non-small cell lung cancer and treated with anticancer chemotherapy. On the 29th day of chemotherapy, the patient had slight upper abdominal fullness and pain. Ultrasonography showed gas flow in the portal vein and computed tomography confirmed the presence of gas in the peripheral lesion of the liver. We made a diagnosis of hepatic portal venous gas. He was successfully treated with conservative management. No mechanical or bacterial factors were identified, and the occurrence of HPVG in our case was considered to be related to his cancer-bearing condition and the chemotherapy agents. Although HPVG during chemotherapy is extremely rare, we should be aware of this complication in patients undergoing chemotherapy.