Accidental retropharyngeal dissection extending close to the right common carotid artery during nasotracheal intubation: a case report.

BACKGROUND: Retropharyngeal dissection is a possible complication during nasotracheal intubation. We report a case of a retropharyngeal dissection extending close to the right common carotid artery occurring while inserting a nasotracheal tube. CASE PRESENTATION: An 81-year-old woman, scheduled for laparoscopic and endoscopic cooperative surgery for a duodenal tumor under general anesthesia, sustained submucosal dissection of the retropharyngeal space during nasotracheal intubation. Postoperative computed tomography revealed retropharyngeal tissue injury extending close to the right common carotid artery. The patient was treated with prophylactic antibiotic therapy and discharged uneventfully on postoperative day 13. CONCLUSIONS: Submucosal dissection of the retropharyngeal tissue during nasotracheal intubation has a potential risk of major cervical vessel injury. Therefore, when the tip of the tube cannot be visualized within the oropharynx, clinicians must proceed with caution regarding the expected depth of the tube.

[A Case in Which Inferior Vena Cava Stent Placement Was Effective for Inferior Vena Cava Stenosis Due to Metastatic Liver Tumor].

A 60s woman was diagnosed with cecal cancer with multiple liver metastases(final pathology was T4aN1M1[H1])and underwent ileocecal resection and D3 dissection. She did not wish for postoperative chemotherapy and surgical treatment of liver metastases. One and a half years after surgery, she developed extremity edema of lower legs and hypoalbuminemia, and she gained 20 kg. Contrast-enhanced CT showed stenosis of the inferior vena cava due to liver metastases, which was markedly improved the symptoms by placement of an inferior vena cava stent. Inferior vena cava stent placement is a minimally invasive treatment and can be an option as it can be expected to improve quality of life in some cases.

Efficacy and safety of semaglutide in glycemic control, body weight management, lipid profiles and other biomarkers among obese type 2 diabetes patients initiated or switched to semaglutide from other GLP-1 receptor agonists.

PURPOSE: Evidence of the efficacy and safety of semaglutide among patients with type 2 diabetes who were initiated on or were switched to semaglutide from other GLP-1 RAs remains limited. The objective of this study was to investigate the short-term effects of switching to semaglutide from other GLP-1 RAs. METHODS: This retrospective cohort study evaluated patients with type 2 diabetes who were initiated on or were switched to semaglutide due to poor diabetes control with other GLP-1 RAs or other medications, or obesity. HbA1c, body weight, serum creatinine, serum uric acid, parameters of lipid metabolism, and parameters of liver function were measured before and 6 months after administration of semaglutide. RESULTS: A total of 50 patients were registered in the study. After switching to semaglutide (n = 43), HbA1c and body weight significantly decreased (p < 0.01, p < 0.01), respectively. The same findings were observed in semaglutide-naïve patients (p = 0.04, p < 0.02) (n = 7). Serum uric acid, total cholesterol, triglycerides, and urinary albumin-creatinine ratio decreased significantly as well (p = 0.04, p = 0.04, p = 0.02, p = 0.04), whereas serum creatinine did not change significantly (p = 0.51). CONCLUSIONS: Semaglutide showed excellent efficacy, even in patients switched from other GLP-1 RAs. Semaglutide appears to be a promising agent for blood glucose and body weight control in obese type 2 diabetes mellitus patients and could be more potent in treating type 2 diabetes than existing GLP-1 RAs.

Changes in Levels of Biomarkers Associated with Adipocyte Function and Insulin and Glucagon Kinetics During Treatment with Dapagliflozin Among Obese Type 2 Diabetes Mellitus Patients.

OBJECTIVES: This study aimed to investigate changes in levels of biomarkers associated with adipocyte function and insulin and glucagon kinetics after a meal tolerance test (MTT) during treatment with dapagliflozin among obese type 2 diabetes mellitus (T2DM) patients. METHODS: T2DM patients with hemoglobin A1c (HbA1c) levels >6.5 % and body mass index (BMI) >25 kg/m2 were treated with dapagliflozin 5 mg/day for at least 12 weeks. HbA1c, body weight, ketone bodies, adiponectin, plasminogen activator inhibitor-1 (PAI-1), and C-reactive protein (CRP) were measured before and after treatment with dapagliflozin. A subset of patients underwent an MTT. RESULTS: Of 27 participating patients (mean age 47.9 years; 17 males), five were drug-naive and 22 were treated with other antidiabetic agents, including insulin and glucagon-like peptide-1 (GLP-1) receptor agonists. Following treatment with dapagliflozin, HbA1c levels significantly improved (7.44 ± 0.56 to 6.70 ± 0.0.57 %; p < 0.01), body weight significantly decreased (90.9 ± 16.5 to 87.1 ± 15.9 kg; p < 0.01), ketone bodies increased, adiponectin significantly increased, and high-sensitivity CRP tended to decrease. During the MTT, blood glucose ΔAUC2 significantly decreased, glucagon ΔAUC2 increased, and immunoreactive insulin (IRI) did not change in 11 of 27 patients. CONCLUSION: Although ketone bodies increased significantly, adiponectin increased and high-sensivity CRP decreased significantly. These findings suggest that sodium-glucose cotransporter-2 (SGLT2) inhibitors may potentially improve adipocyte function in treating obese T2DM patients.

Dipeptidyl peptidase-4 inhibitor (vildagliptin) improves glycemic control after meal tolerance test by suppressing glucagon release.

AIM: We aimed to evaluate changes in insulin and glucagon secretion, as well as glucose levels, with a meal tolerance test (MTT) before and after 6 months of treatment with vildagliptin in a clinical setting. MATERIALS AND METHODS: Participants were 15 patients with uncontrolled type 2 diabetes mellitus (glycated hemoglobin [HbA1c] over 6.9% for more than 3 months). MTTs were conducted before and 6 months after addition of vildagliptin (50 mg twice daily [bid]). Blood samples were collected immediately before, and 1 and 2 h after the test meal for measurement of blood glucose concentration, immune-reactive insulin (IRI), and glucagon. HbA1c was measured at 6 months. RESULTS: Mean age of participants was 55.5 ± 2.8 years, and ten (66.7%) were male. Mean HbA1c significantly improved from 7.6 to 6.8% at 6 months after addition of vildagliptin. Blood glucose at 1 and 2 h after the test meal was significantly reduced after addition of vildagliptin, while the reduction in glucagon showed borderline significance and IRI showed no difference. In a comparison of blood glucose-related parameters between subgroups based on median glucose change in area under the curve during MTT (ΔAUC0-2h), glucagon ΔAUC0-2h was significantly lower in the group with more improved glucose levels (ΔAUC0-2h ≥65 mg/dL), but that of IRI did not differ. CONCLUSION: Suppression of glucagon release by vildagliptin may improve glycemic control without increasing insulin levels in patients with type 2 diabetes.

[Possible predictors of discontinuation of basal-flow of postoperative patient-controlled analgesia].

BACKGROUND: The purpose of this study was to identify possible predictors of discontinuation of basal-flow of postoperative patient-controlled analgesia. METHODS: We reviewed postoperative pain assessment records by the postoperative pain service team from April 2010 to July 2011 in which surgical patients were provided with intravenous or epidural patient-controlled analgesia (IV-PCA or Epi-PCA). From these data, we extracted cases with discontinuation of basal-flow of PCA, and candidate variables such as patients' characteristics, preoperative and intraoperative variables were assessed. Predictors with significant univariate association (P < 0.20) with the primary outcome were used to construct multivariable logistic regression models. RESULTS: We enrolled 685 patients for IV-PCA and 606 for Epi-PCA and obtained discontinuation groups (105 and 73 cases, respectively) with this cohort data. Results of multivariate analysis showed female, non-laparotomy, low body weight, and non-droperidol as independent risk factors for IV-PCA and low body weight, no-co-existing disease, and gastrointestinal surgery for Epi-PCA. There were no significant differences in pain intensity between discontinuation and non-discontinuation cases. The primary cause of discontinuation was PONV for IV-PCA and hypotension for Epi-PCA, respectively. CONCLUSIONS: We should apply IV-PCA for female slender surgical patients undergoing non-laparotomy with great caution and provide prevention for PON. We should pay attention to incidence of postoperative hypotenion when we administer Epi-PCA to slender gastrointestinal surgical patients without co-existing disease.

Application of prophylactic gel-pads for transcutaneous pacing in patients with complete right bundle-branch block with axis deviation when surgical procedures are performed: 10-year experience from a single Japanese university hospital.

This retrospective study aimed to determine whether prophylactic transcutaneous pacing is required for patients with complete right bundle-branch block (CRBBB) and axis deviation (AD), so-called bifascicular block, when surgical procedures are performed under general or local anesthesia. The authors reviewed 34 063 anesthesia cases that took place at Nara Medical University Hospital during a 10-year period (1996-2005). The anesthesia records of all identified patients having CRBBB or bifascicular block were retrospectively reviewed and the incidence of block progression to complete heart block or bradycardia requiring temporary transcutaneous pacing served as the primary endpoint. As a secondary endpoint, the incidence of block progression to complete heart block or bradycardia requiring only medical treatment was checked. Seventy of the 34 063 patients (0.2%) had CRBBB with AD. Only 1 patient with CRBBB with left AD, who underwent on-pump aorto-coronary bypass grafting surgery, developed complete heart block at the resumption of heartbeat. None of the other 69 patients, except for this cardiac case, developed complete heart block during surgery. Based on this analysis of 70 cases, prophylactic gel-pad electrode application in patients with CRBBB and AD does not appear to be necessary during surgical procedures.

Oxidative stress-responsive transcription factor ATF3 potentially mediates diabetic angiopathy.

Previous results of our cDNA microarray analysis to look for genes whose expression level correlates well with in vitro tubulogenesis by NP31 endothelial cells revealed the transcription factor ATF3 known to be responsive to stress such as reactive oxygen species (ROS). Anti-ATF3 small interfering RNA gave an inhibitory influence on tube formation by NP31 cells expressing an activated form of the vascular endothelial growth factor receptor 1 (VEGFR-1) kinase. When expression of ATF3 was regulated under the control of tetracycline system in NP31 cells, they acquired the tubulogenic ability upon ATF3 induction. While ATF3 failed to induce expressions of VEGF and VEGFR, it regulated those of CDK2, CDK4, p8, plasminogen activator inhibitor 1, integrin alpha1, subunit and matrix metalloprotease MMP13. In H2O2-stimulated NP31 cells as well as endothelial cells of glomerulus and aorta of Otsuka-Long-Evans-Tokushima-Fatty diabetic model rats, concomitantly enhanced expressions of ATF3, PAI-1, and p8 were observed. Given the proposed hypothesis of the close linkage between diabetic angiopathy and ROS, those data suggest that ROS-associated diabetic complication may involve ATF3-mediated pathological angiogenesis.