[Two cases of extreme hemodilution caused by massive hemorrhage immediately after start of operation].

We describe two cases of extreme hemodilution due to large amounts of fluid infusion for unexpected massive hemorrhage. In both cases, unexpected hemorrhage with difficult hemostasis occurred within 60 min after the start of the operation. For lack of transfused blood, large amounts of fluid infusion using crystalloid and colloid solutions including 5% albumin, plasma expander and lactated Ringer's solution were administered to maintain circulatory blood volume. The hemoglobin concentration and hematocrit had been below 2.0 g.dl-1 and 10% for approximately one hour, respectively. The extreme hemodilution improved by the urgent blood transfusion. In one case, intraoperative autotransfusion with Cell-Saver was performed. In spite of intraoperative extreme hemodilution, their postoperative courses were uneventful. Intraoperative awareness was present in both cases.

[Intra-arterial chemotherapy with 5-FU (weekly high dose 5-FU HAI) for the prevention of tumor recurrence in residual liver after hepatic resection of metastasis from colorectal cancer].

Intra-arterial cancer chemotherapy using an implantable reservoir was performed for the prevention of tumor recurrence in residual liver after resection of a metastatic tumor from colorectal cancer. Four cases of synchronous hepatic metastases and one case of metachronous hepatic metastasis, which were in H1 (2 cases) and H2 (3 cases), were treated. 5-FU was administered in a dose of 1,000 mg/m2 5 hours weekly (weekly high dose 5-FU HAI). The longest survival obtained is 1Y 11M. Other cases have survived for 1Y 7M, 1Y 12M, 9M, and 3M. Tumor recurrence was not observed in all cases except one. This case had a residual tumor because the complete resection was impossible. The tumor recurrence rate in patients treated with surgery alone at Nikko Memorial Hospital (n = 11) was 63.6%. The 1- and 2-year survival rate in these patients was 60.6% and 26.9%, respectively. As compared to these rates, the results of this study were very favorable. Although mild nausea and abdominal discomfort were observed in 1 patient, this adverse effect was reduced by administration of an anti-ulcer agent. Only a slight decrease of WBC and PLT counts was observed. Consequently, for residual liver after resection of hepatic metastasis from colorectal cancer, this intraarterial chemotherapy with 5-FU is considered to be effective to prevent tumor recurrence and thus to prolong survival.

[Dental treatment under general anesthesia of a patient with pulmonary atresia with intact ventricular septum].

A case of pulmonary atresia with intact ventricular septum in a 4-year-4-month boy, whose dental treatment was performed under general anesthesia, was reported. For the general anesthesia, the medication Digoxin was stopped 24 hours before the treatment. For the prevention of bacterial endocarditis, medication consisting on antibiotics of the penicillin series was administered 24 hours before the treatment. The anesthesia was administered with the modified N.L.A. method with Ketamine and Diazepam. The dental treatment went smoothly, and was finished within 1-hour-15 mins from the start. Anesthesia was administered for 1-hour-45 mins. The prognosis was good, and the patient was discharged the next day. It should be noted that as for performing dental treatment under anesthesia or not using anesthesia, there are some different opinions. We think that it must be discussed from the point of view of the effect of the dental treatment on the patient versus the danger of the anesthesia. In this case, we found that, under general anesthesia, stress of the patient was reduced, and the dental treatment was able to be performed smoothly and safely.