Anesthetic management of endovascular stent graft placement for thoracic aortic aneurysm using induction of transient cardiac asystole by ATP

We experienced anesthetic management of endovascular stent graft placement for thoracic aortic aneurysm in a 69-year-old patient. Under general anesthesia, ATP 20 mg was administered intravenously. However, heart rate and blood pressure did not decrease sufficiently for placement of a stent graft. After additional injection of ATP 30 mg, heart rate and systolic blood pressure decreased to 20 bpm and 60-70 mmHg, respectively, enabling the placement of a self-expanded type stent graft in the proper site. No clinical complications related to this procedure were observed. Induction of transient cardiac asystole by ATP is an easy and safe procedure for placement of a stent graft in a patient with thoracic aortic aneurysm.     

Anesthetic management of a patient with hereditary spastic paraplegia

We experienced the anesthetic management of a 39 year-old-male with hereditary spastic paraplegia (HSP) associated with pain due to pes cavus. He underwent orthomorphia ostectomy and tenodesis. Preoperative neurological examination revealed that he had slight dementia, symptoms of the pyramidal tract, lower limb bathyhypesthesia, and neurogenic bladder in addition to spastic paraplegia, and he was diagnosed as having combined type of HSP. Spinocerebellar degeneration is often accompanied with this type of HSP. To avoid the use of muscle relaxants and narcotics, we tried to induce anesthesia with inhalation of nitrous oxide (N2O), oxygen and sevoflurane (sevo). A laryngeal mask (LM) was inserted at the expiratory concentration of sevo 3.5%. Anesthesia was maintained by N2O, oxygen and sevo (2-3%) under spontaneous respiration. The patient recovered from anesthesia after the end of surgery, and the LM was removed smoothly. The patient's respiratory condition was stable, and no problems were found in the postoperative period.     

"Cannot-ventilate" after anesthetic induction in a patient with rapidly increased laryngeal tumor

A 76-year-old male patient with laryngeal tumor was scheduled for elective laryngo-microsurgery. He had no dyspnea nor symptoms of obstructive lung disease detected by spirometry. Preoperative finding by laryngoscopy showed decreased movement of the left vocal cord. However, no significant narrowing was found in the glottis. Following anesthetic induction with fentanyl and thiamylal, the lungs could not be ventilated with anesthesia circuit even by use of oral airway device. After his resuming spontaneous breathing, assisted ventilation became possible. However, the lungs could not be ventilated again after vecuronium i.v. The vocal cords could not be visualized by direct laryngoscopy with a Macintosh blade. The trachea was intubated with a tracheal tube (I.D. 6.0 mm) by blind technique, and mechanical ventilation was established. The intraoperative laryngomicroscopy showed that the laryngeal tumor had grown rapidly occupying the glottis except posterior commissure. We should be careful of rapid preoperative growth of the laryngeal tumor.     

Recurrent low output syndrome after the weaning from mechanical circulatory support for postcardiotomy cardiogenic shock

We reviewed the cases of recurrent low output syndrome (LOS) after the weaning from mechanical circulatory support for postcardiotomy cardiogenic shock. Twelve patients were divide into 2 groups according to whether low output syndrome recurred or not, consisting of a recurrent low output syndrome (+) group [re-LOS (+) group, n = 6] and a recurrent low output syndrome (-) group [re-LOS (-) group, n = 6]. Between 2 groups, there was no statistical difference in preoperative left ventricular ejection fraction (LVEF), aortic closs-clamping time and cardiac index at the weaning from mechanical circulatory support. Only the LVEF at the weaning in the re-LOS (+) group was significantly less than that in the re-LOS (-) group (0.39 +/- 0.08 vs 0.62 +/- 0.19, p < 0.05). All patients in the re-LOS (-) group survived to discharge, while in the re-LOS (+) group, although 3 patients were re-supported by intra-aortic balloon pumping, 4 of 6 patients died of multiple organ failure and 2 survivors were in New York Heart Association class III. The results suggest that the key to survive to discharge after the weaning from mechanical circulatory support is whether the cardiac contraction could recover or not.     

Translation and adaptation of the UCLA prostate cancer index for use in Japan

PURPOSE: To translate the UCLA Prostate Cancer Index (UCLA PCI), which is designed to measure Quality of Life (QOL) of patients with prostate cancer, and to adapt it as needed for use in Japan. METHODS: We translated the original English version into a preliminary Japanese version in a multi-stage procedure according to established guidelines. Then, we tested the preliminary Japanese version on 6 patients with prostate cancer, and we revised the Japanese version based on the findings of the pilot test. RESULTS: The back-translation of the preliminary Japanese version was reviewed by its original developer, and some wordings were revised. In the pilot testing, the average time required to complete the questionnaire was 5.5 minutes. Four of the 20 items frequently had missing data (> 15%). This is believed to have been due to inappropriate wording of the response choices, which were revised accordingly. CONCLUSION: We conducted translation and cross-cultural adaptation of the Japanese version of UCLA PCI. Pilot testing proved to be useful in refining items and response choices.     

Surgical repair of left ventricular free wall rupture using layered fibrin glue sheet and fibrin glue; report of a case

A 57-year-old man with acute myocardial infarction (#13:90%, #6-#8:75%) was admitted to our hospital after the administration of tissue plasminogen activator. Three hours' after emergent percutaneous transluminal coronary angioplasty, he developed left ventricular free wall rupture in the left circumflex artery area. After bleeding was completely controlled by aortic cross clamping, a three-layered of fibrin glue sheet (TachoComb) with fibrin glue was extensively applied to the ruptured site including the infarcted area. He was discharged on the 25th postoperative day and underwent coronary artery bypass grafting to the left anterior descending artery three weeks later. This experience suggests that the layered TachoComb and fibrin glue are effective for left ventricular free wall rupture.     

Mature teratoma arising in intraabdominal undescended testis in an infant with previous inguinal exploration: case report and review of intraabdominal testicular tumors in children

The authors report the youngest case of postoperative intraabdominal mature testicular teratoma in a 5-year-old boy after previous exploration for impalpable testis. A total of 26 cases of intraabdominal testicular tumor in children including our case were reviewed and discussed from both the English- and the Japanese-language literature. The average age was 2.5 years, and, in the 13 children younger than 1 year there were no malignant teratomas, although there was one immature teratoma. Four of these had undergone previous inguinal exploration in which 3 patients except our patient were more than 10 years old. This case report confirms the importance of finding an intraabdominal testis at operation for impalpable testis. Early detection of the testicular location near the internal inguinal ring in these patients supports the hypothesis that the intraabdominal testicular teratoma itself may have been the primary cause of the undescended testis. Furthermore, it is suspected that many of the intraabdominal testicular malignant teratomas in adults may have arisen from these mature testicular teratomas in infants. J Pediatr Surg 37:1236-1238.     

Sporotrichosis in farmers

Eleven cases of sporotrichosis treated in our clinic were statically evaluated and two cases suffered by farmers are presented. In urban areas, because of the great popularity of gardening, patients with sporotrichosis are increasing among gardeners. Because sporotrichosis is an occupational skin disease, enlightenment of farmers and gardeners regarding the importance of prevention of skin injury as a route to infection during farm work or gardening is necessary. In addition, dermatologists have to spread information regarding the fungal infections to the public.     

UDP-GlcNAc2-epimerase regulates cell surface sialylation and cell adhesion to extracellular matrix in Burkitt's lymphoma

Alteration of cell surface glycoconjugates plays a crucial role in many biological phenomenon, including invasion and metastasis. In the present study, we investigated the relationship between cell surface sialylation and the adhesive properties of two clones (3G3 and 3D2) of a human Burkitt's lymphoma cell line, HBL-8 to extracellular matrix. By flow cytometric analysis we found that the cell surface of 3G3 clone was highly sialylated and that of the 3D2 clone were hyposialylated. Moreover, cell surface sialic acid content was significantly greater in the 3G3 clone than in the 3D2 clone. In vitro adhesion assays showed that cell surface sialylation in the 3G3 clone cells might reduce their attachment to collagen type IV and fibronectin, compared to 3D2 clone. Sialic acid metabolic complementation assays using several precursors of sialic acid suggested that hyposialylation in the 3D2 clone resulted from low activities of uridine diphosphate-N-acetylglucosamine-2-epimerase (UDP-GlcNAc2-epimerase) which is a key enzyme in sialic acid biosynthesis. From RT-PCR analysis the expression of UDP-GlcNAc2-epimerase mRNA was found to be correlated with sialic acid content in the two clones of HBL-8. Therefore, expression of UDP-GlcNAc2-epimerase mRNA may regulate the expression of sialoglycoconjugates which affect the adhesion of lymphoma cells to collagen type IV and fibronectin.     

Experience of intravenous digital subtraction angiography (IV-DSA) in evaluation of neoadjuvant chemotherapy for advanced breast cancer

 Intravenous digital subtraction angiography (IV-DSA) was performed before and after neoadjuvant chemotherapy (NACT) in five patients with locally advanced breast cancer, and the efficacy of NACT was evaluated on the basis of the results of IV-DSA and histopathological examination. Following NACT, the maximum density of tumor enhancement (MAX) in the IV-DSA image decreased by 61.6% in case 1, 50% in case 2, 58.1% in case 3, 90.8% in case 4, and 97.2% in case 5. In all five patients, the efficacy of chemotherapy was rated as a partial response in terms of tumor size, while histological efficacy was rated as slightly effective in cases 1–4 and moderately effective in case 5. The pathological efficacy of NACT was highest in case 5, which showed the greatest decrease in MAX. These results indicate that variations in MAX reflect clinical efficacy, and, to some extent, also permit prediction of pathological efficacy. Received: March 4, 2002 / Accepted: June 10, 2002 Correspondence to:O. Watanabe