Anesthetic management for separation of thoracopagus twins with complex congenital heart disease: a case report.

Although thoracopagus twins joined at the upper chest are the most common type of conjoined twins, the separation surgery in these cases has a higher mortality rate. Here, we describe an anesthetic management approach for the separation of thoracopagus conjoined twins sharing parts of a congenitally defective heart and liver. We emphasize the importance of vigilant intraoperative hemodynamic monitoring for early detection of unexpected events. Specifically, real-time continuous monitoring of cerebral oximetry using near-infrared spectroscopy allowed us to promptly detect cardiac arrest and hemodynamic deterioration.

Spectroscopic capture and reactivity of a low-spin cobalt(IV)-oxo complex stabilized by binding redox-inactive metal ions.

High-valent cobalt-oxo intermediates are proposed as reactive intermediates in a number of cobalt-complex-mediated oxidation reactions. Herein we report the spectroscopic capture of low-spin (S=1/2) Co(IV)-oxo species in the presence of redox-inactive metal ions, such as Sc(3+), Ce(3+), Y(3+), and Zn(2+), and the investigation of their reactivity in C-H bond activation and sulfoxidation reactions. Theoretical calculations predict that the binding of Lewis acidic metal ions to the cobalt-oxo core increases the electrophilicity of the oxygen atom, resulting in the redox tautomerism of a highly unstable [(TAML)Co(III)(O˙)](2-) species to a more stable [(TAML)Co(IV)(O)(M(n+))] core. The present report supports the proposed role of the redox-inactive metal ions in facilitating the formation of high-valent metal-oxo cores as a necessary step for oxygen evolution in chemistry and biology.

Anesthesia for non-pulmonary surgical intervention following lung transplantation: two cases report.

The survival rate after lung transplantation has increased in recent years, leading to an increase in non-pulmonary conditions that require surgical intervention. These post-transplant surgical procedures, however, are associated with high mortality and morbidity rates. Intra-abdominal conditions are the most common reasons for surgical intervention. We describe here two patients who underwent abdominal surgery under general anesthesia following lung transplantation. One patient underwent cholecystectomy due to cholecystitis after heart-lung transplantation, and the other patient had an exploratory laparotomy for duodenal ulcer perforation after double lung transplantation. Depending on the type of transplant intervention, the physiology of the transplanted lung must be considered for general anesthesia. Knowledge of underlying conditions and immunosuppressive therapy following transplantation are important for safe and effective general anesthesia.

Central venous catheter-related superior vena cava syndrome following renal transplantation -A case report-.

A 55-year-old man with end-stage renal disease had severe left ventricular dysfunction and a history of deep vein thrombosis. He underwent renal transplantation, during which a central venous catheter was inserted into the right jugular vein. The central venous pressure (CVP) exceeded 20 mmHg throughout the operation but there was no other adverse event. After surgery, although the left ventricular dysfunction improved, the CVP remained high. On postoperative day 10, the patient presented with cyanosis of the arms and redness of the face and was diagnosed with superior vena cava (SVC) syndrome, for which he underwent emergency thrombectomy and SVC reconstruction. The clinical course of this patient suggests that his end-stage renal disease-associated hypercoagulable state may have promoted thrombus formation. Moreover, placing the central venous catheter tip too deep may have encouraged thrombus formation. Repositioning the tip may have prevented this complication.

Flexibility of inorganic tennis ball structures inducing anion selectivity.

Inorganic tennis balls (ITBs), [[{Pt(betmp)(dach)}(2)Cu](2)(X)][X](3) (in which X=ClO(4) (-) (3), NO(3) (-) (4), Cl(-) (5) and Br(-) (6); dach=trans-1,2-diaminocyclohexane and betmp=bisethylthiomethylidenepropanedioate) and [[{Pt(dteym)(dach)}(2)Cu](2)(PF(6))][PF(6)](3) (7; dteym=1,3-dithiepane-2-ylidenemalonate), were prepared as crystals. Investigation of their X-ray crystal structures revealed that shapes of the cavities in ITBs show significant distortions that depend on the properties of the encapsulated anions. The CuCu* distance was observed to be longest in 7 and shortest in 5, the difference between them being 2.05 A. The flexibility of cavity structures of ITBs makes it possible to encapsulate various anions inside the cavity, while their distortions may be a reason for the difference in the encapsulating ability for anions, that is, anion selectivity. Especially, the distortions observed in 7 are so severe that the encapsulating ability of the cavity for PF(6) (-) is very low compared to other anions. The shapes of ITBs with ClO(4) (-) and BF(4) (-) ions inside their cavities are very similar; however, ClO(4) (-) is encapsulated by the cavity better than BF(4) (-), which is explicable by the difference of metal-anion interactions. This structural study on ITBs gives a clue to the origin of the anion selectivity of the cavity in ITBs previously investigated by (19)F NMR spectroscopy of the ITBs in methanol.