[Caesarean section in a patient with past history of fulminant malignant hyperthermia].

Caesarean section in a 26 year old patient (50 kg, normal weight 36 kg) with past history of fulminant malignant hyperthermia (f-MH) is reported. Hyperthermia over 42 degrees C and subsequent cardiac arrest occurred during general anesthesia with nitrous oxide-oxygen-halothane and succinylcholine when she had been planned to perform hip joint arthroplasty at the age of 7. Prophylactic oral dantrolene administration started 4 days before the operation and the dose went up to 75 mg. Further 25 mg was given as premedication on the day of the operation. Intravenous dantrolene was administered 1.2 mg.kg-1 during the operation and 0.6 mg.kg-1 on the day after surgery. The Caesarean section was performed under spinal anesthesia with hyperbaric tetracaine 20 mg. No clinical symptoms of MH occurred during perioperative period. The delivered baby was a healthy female and no side effects of dantrolene were observed.

[NSAIDs (non steroidal anti-inflammatory drugs) for the treatment of rheumatoid arthritis].

Non-steroidal anti-inflammatory drugs (NSAIDs) are often prescribed to patients with rheumatoid arthritis (RA), as the first line drugs, and are administered over a long term. NSAIDs are classified principally into acidic and basic preparations, and the former is more widely used for the treatment, since the latter possesses no anti-rheumatic effect. Moreover, the acidic NSAIDs are classified into salicylates, arylacetic acid, pyrazolone, fenamates and oxicams. Arylacetic acid has a strong analgesic effect. Pyrazolone is well balanced between analgesic, anti-inflammatory and antifebrile effects. The fenamates and oxicams are long acting. On the other hand, NSAIDs sometimes inhibit adverse reactions, such as gastroduodenal diseases and renal insufficiency, which are probably induced by the inhibition of cyclo-oxygenase to reduce prostaglandin content. Therefore, appropriate NSAIDs must be selected after consideration on the character, property and adverse reaction of each drug.

[Felty's syndrome].

Felty's syndrome is a variant of rheumatoid arthritis with a triad of leukopenia, splenomegaly and typical rheumatoid arthritis, and often accompanies the other extraarticular symptoms, such as subcutaneous nodules, lymphadenopathy, anemia, thrombocytopenia, leg ulcers, fever and weight loss. In addition to the decreased number of leukocyte, impaired functions of leukocytes were also revealed. These changes were considered as the cause of repeated infections, which was the major cause of death in Felty's syndrome. Splenectomy is not fully effective for leukopenia and for the repeated infection. Glucocorticoid therapy can increase leukocyte count, at least tentatively. It has been reported that gold was effective for leukopenia, repeated infection and skin ulcer. However, the definitive way of treatment of this syndrome based on the pathogenesis of this syndrome, remains to be established.

[Differential lung ventilatory management during bronchoplasty].

We compared two methods of respiratory managements during bronchoplasty surgery. In one lung ventilation group (OLV-G), 10 patients were ventilated with Broncho-cath tube or Univent tube. On another 10 patients, ventilation was performed with Univent tube following insertion of bronchial blocker into main bronchus of dependent lung. Dependent lung was then ventilated using high frequency jet ventilation (HFJV) through bronchial blocker superimposed with low tidal volume IPPV (selective HFJV, S-HFJV-G). Oxygenation index (O.I.) of S-HFJV-G was significantly higher than that of OLV-G when bronchus was open. These phenomena might have occurred through prevention of pulmonary blood flow shift to the non-dependent lung when S-HFJV was used.