A case of intraoperative hyperkalemia probably due to preoperative feeding with a liquid enteral formulation

A 67-year-old man with no remarkable preanesthetic complications underwent esophagectomy. The patient was fed only with a liquid enteral formulation (Ensure Liquid) for 5 days immediately before the operative day. His serum potassium level before Ensure Liquid administration was 4.1 mEq x l(-1). The first blood analysis at 30 min after the initiation of the surgery revealed an increase in serum potassium level (5.9-6.1 mEq x l(-1)) without any conceivable cause during the anesthetic management. A glucose-insulin infusion treatment lowered the serum potassium level to the normal range. The serum potassium level re-increased to 6.4 mEq x l(-1) 4 days after the initiation of jejunal feeding with Ensure Liquid and then returned to the normal range after the termination of Ensure Liquid administration. The patient's perioperative course suggests that the preoperative Ensure Liquid administration is a probable cause of the intraoperative hyperkalemia in this case.     

Anesthetic management of a patient with acute idiopathic pandysautonomia

Acute idiopathic pandysautonomia (AIPD) is a very rare disease with acute onset of impairment in the peripheral sympathetic and parasympathetic nerves. We report the anesthetic management of a patient with AIPD undergoing bladder lithotomy and scrotum abscess drainage. A 64-year-old man had a severe orthostatic hypotension, and was extremely sensitive to intravenous norepinephrine because of denervation hypersensitivity. Before the surgery, the patient was sufficiently hydrated. We planned to administer a vasopressor (phenylephrine) and a vasodilator (nicardipine) at 1/10 of usual doses. After placement of a radial artery catheter, combined epidural and spinal anesthesia was performed with the patient in a right lateral position. Blood pressure decreased slightly after placing him in a supine position. However, no medication was needed, and the patient showed no perioperative complications.     

Partial pericardial defect associated with ruptured aortic dissection of the ascending aorta: a rare feature presenting severe left hemothorax without cardiac tamponade

We report a very rare case of acute aortic dissection of the ascending aorta, which ruptured to the left pleural cavity through the left-side congenital pericardial defect. A preoperative computed tomographic scan and a roentgenogram showed localized dissection of the ascending aorta and severely deteriorating left hemothorax, which required emergency operation. Intraoperative findings revealed the ruptured aortic dissection of the ascending aorta and the defect at the left-side pericardium, and a graft replacement of the ascending aorta was performed. It was considered that congenital pericardial defect complicates the diagnosis in a case of catastrophic intrapericardial hemorrhage.     

Role of macrophages in a mouse model of postoperative MRSA enteritis

BACKGROUND: We have established a mouse model for fatal postoperative enteritis due to Staphylococcus aureus to analyze mechanisms of bacterial translocation and determine reasons for the lethality of this infection. In the present study the role of macrophages was ascertained in protection against S. aureus induced enteritis. MATERIALS AND METHODS: Mice were pretreated with cyclophosphamide (CY), an immunosuppressant, and then infected directly into the jejunum with methicillin-resistant S. aureus (MRSA) isolated from a patient. In other groups of mice liposome-encapsulated dichloromethylene diphosphate (Cl2MDP) was administered to deplete macrophages in vivo. Other experimental groups received lipoteichoic acid (LTA), which was used to inhibit the ability of macrophages to bind MRSA, and additionally, to analyze dependence of bacterial clearance on the macrophage scavenger receptor. The ability of macrophages to bind MRSA was compared with survival rates in this mouse model of fatal postoperative enteritis. RESULTS: Injection of liposome-encapsulated Cl2MDP decreased survival rate of mice infected intraintestinally with MRSA in a dose-dependent manner. Cyclophosphamide also decreased survival rate of MRSA-infected mice and was found to correlate with its ability to decrease the number of macrophages in the spleen. Intravenous LTA administration did not affect total splenocyte numbers or the number of splenic macrophages but decreased the ability of macrophages to bind MRSA and adversely affected survival of mice infected with MRSA. CONCLUSIONS: Macrophages play a critical role in protection against MRSA administered directly into the jejunum. LTA recognition sites (probably type A scavenger receptors) on macrophages are required for binding and phagocytosing MRSA.     

Effects of ellagic acid and 2-(2,3,6-trihydroxy-4-carboxyphenyl)ellagic acid on sorbitol accumulation in vitro and in vivo

Caesalpinia ferrea MART. (Leguminosae) called as Juca is one of the medicinal plants in Brazil used for diabetes. From the fruits of this plant, ellagic acid (EA) and 2-(2,3,6-trihydroxy-4-carboxyphenyl)ellagic acid (TEA) have been recently isolated as aldose reductase (AR) inhibitors. In this study, we examined to prove the inhibitory activity against AR of EA and TEA in vitro, and EA in vivo by measurement of the accumulation of sorbitol, which is the product of glucose reduction catalyzed by AR. TEA was not examined in vivo because of its shortage of yield from the fruits. EA and TEA significantly and dose-dependently inhibited sorbitol accumulation in erythrocytes, lens and sciatic nerve under incubating with glucose in vitro. EA at a dose of 75 mg/kg/d showed the most potent inhibition of sorbitol accumulation in erythrocytes, lens and sciatic nerve at 50, 75 and 100 mg/kg/d in vivo. These results suggest that the inhibitory activity of EA against AR causes to inhibit sorbitol accumulation by in vitro and in vivo experiments. EA is distributed in fruits and vegetables, so that taking them might be able to relieve diabetic complications.     

Structure of tyroscherin, an antitumor antibiotic against IGF-1-dependent cells from Pseudallescheria sp

An antitumor antibiotic, tyroscherin, was isolated from the culture of a fungus identified as Pseudallescheria sp. The structure of tyroscherin including the absolute stereochemistry was determined as shown in Fig. 1 by NMR and degradation studies. Tyroscherin selectively inhibited IGF-1-dependent growth of MCF-7 human breast cancer cells with an IC50 of 9.7 ng/ml.     

Synthesis and structure-activity relationships of 5,6,7,8-tetrahydro-4H-thieno[3,2-b]azepine derivatives: novel arginine vasopressin antagonists

A variety of novel heterocyclic compounds having thienoazepine, pyrroloazepine, furoazepine, and thienodiazepine skeletons were synthesized, most of which exhibited potent antagonism of [(3)H]-AVP specific binding in assays using rat liver (V1), rat kidney (V2), human platelet plasma membranes, and recombinant human CHO cells (V2), as well as antagonizing AVP-induced hypertension in rats (V1, intravenous) and showing a diuretic effect in rats (V2, oral). By detailed studies of the structure-activity relationships of these compounds, the thienoazepine derivative 1 was found to be a very potent combined V1 and V2 antagonist. After further pharmacological and toxicological evaluation as well as physical properties, the hydrochloride 2 (JTV-605) of compound 1 was selected for clinical studies as a potent AVP antagonist with a long duration of action.     

Aggressive multimodal treatment for peritoneal dissemination and needle tract implantation of hepatocellular carcinoma: a case report

We encountered a patient with hepatocellular carcinoma (HCC) with peritoneal dissemination and needle tract implantation, both of which were strongly suspected to have been caused by percutaneous needle biopsy. The patient was a 65-year-old man. Partial hepatectomy of subsegment VI had been performed following the diagnosis of HCC by percutaneous needle biopsy in February 1997. After this first surgery, the patient additionally underwent five further surgeries for the treatment of intrahepatic recurrences, peritoneal recurrences and needle tract implantation caused by the percutaneous needle biopsy. The intrahepatic and peritoneal recurrences were surgically controlled for 3 years after the fifth operation. The needle tract implantation was first resected in February 2001. Since then, treatment by surgery and radiotherapy has been administered twice for local recurrences forming tumor thrombosis of the abdominal wall. Now, 7 years after the first surgery, the patient remains alive without any evidence of recurrence. This case report serves to emphasize that needle tract implantation and peritoneal seeding caused by percutaneous needle biopsy are rare but possible complications. When such iatrogenic spreading of malignant cells occurs, aggressive multimodal treatment is well worth considering. Wide resection of the tumor including the adjacent soft tissues should be performed in these cases, considering that the tumor spreads along the subcutaneous veins in needle tract implantation of HCC and repeated aggressive surgeries could provide good local control.     

A case of successful treatment with combined 5-fluorouracil, adriamycin, cisplatin (FAP) therapy followed by Gemcitabine, UFT therapy and intra-arterial FAP therapy for unresectable advanced gallbladder cancer

The prognosis of unresectable advanced gallbladder cancer is extremely poor. We presented a 61-year-old female with unresectable advanced gallbladder cancer who received FAP therapy, Gemcitabine + UFT therapy, and an intra-arterial FAP therapy that followed. She is still alive 18 months after the first diagnosis. It may be possible to improve the prognosis by maintaining QOL using the combination of chemotherapies such as FAP, Gemcitabine, and UFT.     

Effect of type I growth factor receptor tyrosine kinase inhibitors on phosphorylation and transactivation activity of the androgen receptor in prostate cancer cells: Ligand-independent activation of the N-terminal domain of the androgen receptor

Although there have been several studies suggesting the involvement of growth factor receptor tyrosine kinases in ligand-independent activation of the androgen receptor (AR) and progression of prostate cancer, limited studies have been reported actually showing the enhancement of phosphorylation of the AR in vivo in response to growth factors or activation of their receptors in prostate cancer cells. In this study, we have demonstrated that overexpression of HER2/Neu enhanced in vivo phosphorylation of the AR and MAP kinase in DU-145 cells, and that the HER2/Neu inhibitor TAK165 reduced the HER2/Neu-enhanced phosphorylated AR and MAP kinase, indicating that the MAP kinase pathway seems to be involved in the phosphorylation of the AR by HER2/Neu. Both HER2/Neu inhibitor TAK165 and EGFR tyrosine kinase inhibitor gefitinib ('Iressa', ZD1839) successfully reduced the HER2/Neu-induced transactivation activity of the AR in PC-3 and DU-145 cells, suggesting that these inhibitors are possible therapeutic drugs for patients with hormone-refractory prostate cancer. The transactivation activity of the AF-1+DBD of the AR was enhanced by HER2/Neu overexpression while that of the AF-2+DBD was not, demonstrating that the enhancement of the AR activity by HER2/Neu was mainly mediated through the AF-1 of the AR.