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Background: bronchoscopy is a relatively invasive procedure, and standard anesthesia is often inadequate. The recently introduced transcutaneous carbon dioxide (tcpCO2) monitoring has become a convenient surrogate method for continuous monitoring of the partial pressure of arterial carbon dioxide (PaCO2). The objective of this study was to evaluate the safety of additional use of propofol during bronchoscopy by transcutaneous blood gas monitoring. Methods: patients in whom transcutaneous gas monitoring was performed during bronchoscopy were included in this study. The study subjects were divided into two groups: 1) the midazolam + fentanyl group (MF group), and 2) the group in which midazolam was switched to propofol because of inadequate sedation with midazolam + fentanyl (MFP group). We conducted a retrospective analysis of the transcutaneous gas measurement data obtained during bronchoscopy. Results: data of a total of 61 patients (MF group, n=41; MFP group, n=20) were analyzed. The duration over which the tcpCO2 remained over 50 mm Hg was longer in the MFP group (MF 0.0 min vs. MFP 7.8 min, p=0.042). The percentage of patients in whom the tcpCO2 rose to over 50 mm Hg was also higher in the MFP group (MF group, 14.6% vs. MFP group, 65.0%). None of the patients required discontinuation of the bronchoscopic procedure due to inadequate sedation. Conclusions: while the addition of propofol improved the tolerability of the procedure in difficult-to-sedate patients, it was also associated with a higher risk of ventilatory failure and hypoxemia. Thus, in order to ensure safety, additional propofol should be used with caution under continuous pCO2 monitoring, such as by transcutaneous measurement. Trial registration: this study was conducted with the approval of the Clinical Research Management Division of Dokkyo Medical University (Approval No.: R-15-5J) under the supervision of a well-trained bronchoscopist. The contents of the study were disclosed in an opt-out format.

A 28-year-old woman was hospitalized for cardiac tamponade caused by tuberculous pericarditis. She was taking ustekinumab (UST) for Crohn’s disease. UST is not considered to significantly increase the risk of developing serious infections, including tuberculosis. However, there is still a risk of Mycobacterium tuberculosis reactivation. Therefore, for patients on concurrent UST and antituberculosis medication, a close collaboration among specialists in infectious diseases, cardiology, and gastroenterology is necessary.

Histiocytic sarcoma (HS), an extremely rare malignancy, usually follows a progressive time course, and patients die within two years of diagnosis. At present, there is no consensus for effective chemotherapy. We report the case of a 54-year-old man who presented with low back pain and left hip joint pain. Imaging for the pain revealed multiple lesions in the mediastinum, vertebral bodies, and left ilium. Biopsies of the mediastinal and vertebral lesions yielded a diagnosis of soft tissue sarcoma. He received standard chemotherapy for sarcoma with doxorubicin and ifosfamide, as the initial pathological diagnosis was soft tissue sarcoma. This is called AI therapy and commonly used for soft tissue sarcoma. Palliative radiation therapy to the left iliac lesion was added for pain control. Complete remission (CR) was achieved after two courses of AI therapy. Subsequent immunopathological examination revealed that the tumor was spindle cell dominant HS. CR was maintained for more than three years. To the best of our knowledge, this is the first report that a CR was achieved by AI therapy as first-line treatment for spindle cell dominant HS, combined with focal bone palliative irradiation. AI therapy could be an effective option as chemotherapy for HS.

Co-infection with cryptococcus and tuberculosis has rarely been reported. We herein report a case of an 80-year-old man with cryptococcal pleuritis concurrent with pulmonary tuberculosis. He was admitted for progression of left pleural effusion and consolidation in the left upper lobe. Culture for Mycobacterium tuberculosis was positive in sputum, and analyses of pleural effusion revealed lymphocyte-predominant high levels of adenosine deaminase (ADA). Medical thoracoscopy revealed massive infiltration of Cryptococcus neoformans in pleura without granuloma. This is the first case report of cryptococcal pleuritis coincident with pulmonary tuberculosis. Cryptococcal pleuritis should be ruled out when the adenosine deaminase levels are elevated in pleural effusion.