Yuji Akiba

Hypoxic ventilatory depression in a patient with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes

We describe a case of a 21‐year‐old man with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke‐like episodes (MELAS) who presented with hypoxic ventilatory depression. He had chronic hypoventilation, which was not explained by weakness of respiratory muscles. His hypercapnic ventilatory response was not impaired. In contrast, hypoxic ventilatory depression was observed in the isocapnic progressive hypoxic response test. After exposure to hypoxic conditions, his respiratory frequency decreased and tidal volume was unchanged. The hypoxic ventilatory depression was partially blocked by pretreatment with aminophylline. In conclusion, we need to be careful with patients with MELAS who are hypoxaemic because a vicious circle of hypoxia and hypoventilation can occur.

Effects of Photodynamic Therapy in Inoperable Early Stage Lung Cancer Patients.

中枢型早期肺癌8例に対しphotodynamic therapy (PDT) を施行した. 全例がRoentogenographically occult lung cancer (ROLC) で, 組織型は扁平上皮癌であった. TNM分類では, TisN0M0が6例8病巣 (多発癌2例), T1N0M0が2例2病巣であった. 腫瘍径は10mm未満が6例7病巣, 10mm以上が2例3病巣であった. 治療効果の判定は, PDTを施行した2週後の気管支鏡検査所見と, 2週後及び4週後の喀痰細胞診にて総合的に判定した. PDTの結果, 1.8症例中complete response (CR) を5例, Partial response (PR) を3例得た. 2. 深達度ではCisの6例中5例, 8病巣中6病巣にCRを得た. 3. 腫瘍径では10mm未満の6例中5例, 7病巣中5病巣にCRを得た. 4. CRの1例2病巣 (多発例), PRの2例2病巣に放射線治療を追加しCRを得た. 5. 死因は, 5例中3例が重複癌死, 2例が他病死, 原発癌死はなかった. 生存期間は, 重複癌の進行で8カ月後に死亡した1例を除いては39～120カ月 (中間値50カ月) で, 5年以上の生存は3例であった.