We experienced 6 cases of intractable perioperative myocardial ischemia with coronary spasm that was successfully treated with fasudil, a Rho-kinase inhibitor. Three of the patients (aged 49-81 years) showed ST elevation on electrocardiograms and abrupt circulatory collapse after off-pump coronary artery bypass grafting. Emergeny coronary angiogram revealed severe spasm of their own coronary arteries and/or bypass grafts. Since intracoronary and/or intragraft injection of isosorbide dinitrate (ISDN) was ineffective, we administered fasudil into the spastic vessels, and that completely resolved the spasm. The other 3 patients (aged 55-77 years) suffered myocardial ischemia during the operation, though intravenous vasodilators including ISDN, diltiazem and nicorandil had been administered continuously. Their ischemia occurred when the aorta was declamped, the pericardium opened, or the bypass graft was anastomosed, respectively. We decided to use fasudil in these cases since ISDN was ineffective, or severe spasm was found on intraoperative inspection. Administration of fasudil successfully relieved the ischemia, and subsequently all 3 patients could be weaned from the cardiopulmonary bypass during the operation. Fasudil completely resolved the myocardial ischemia in all 6 patients. In conclusion, fasudil, a Rho-kinase inhibitor, is a useful agent for perioperative myocardial ischemia including coronary spasm that is resistant to intensive conventional vasodilator therapy. We should administer fasudil and relieve spasms as early as possible to rescue patients with intractable ischemia.

Objective: Macrolide therapy has been recommended as an effective treatment for pediatric otolaryngology patients with conditions such as chronic sinusitis and otitis media with effusion.  However, in many cases, a relapse may occur after cessation of treatment.  Therefore, patients are compelled to continue taking antibiotics.  In this paper, we examined the relationship between the duration of therapy and period to relapse on the basis of prescription information and literature research.
Methods: To evaluate the therapeutic doses, we investigated the clinical doses of erythromycin and clarithromycin used for pediatric patients in a community pharmacy from January 2009 to July 2009.  Further, we performed literature searches on the doses of both drugs using Igaku-Chuo-Zasshi databases (from 1983 to 2011) and compared the data obtained with the clinical doses.  Accordingly, the oral doses of macrolides were classified as a low dose or normal dose.  We analyzed the relationship between the administration period and the cessation period, which was defined as the period from the cessation of the treatment to relapse.
Results: Review of the 17 selected reports and the clinical doses showed that the maximum dose of erythromycin was 15 mg/kg/day and that of clarithromycin was 8 mg/kg/day during therapy.  When both cephem or penicillin antibiotics and low-dose macrolides were taken continuously during the administration period, a weak correlation was observed between the administration period and the cessation period.
Conclusion: These results may be useful for the appropriate use of antibiotics and for preventing relapse in pediatric otolaryngology patients.