Serum CA125 level as predictors of the efficacy of olaparib maintenance therapy for platinum-sensitive relapsed ovarian cancer.

AIM: Ovarian cancer is a gynecological malignancy with a poor prognosis. For platinum-sensitive relapsed ovarian cancer, maintenance therapy with poly-ADP ribose polymerase (PARP) inhibitors after chemotherapy is considered; however, olaparib treatment does not always lead to sufficient progression-free survival (PFS). This study aimed to identify factors that predict the efficacy of maintenance therapy using olaparib in platinum-sensitive relapsed ovarian cancer. METHODS: Twenty-seven patients with platinum-sensitive relapsed ovarian cancer, who received initial treatment and showed complete or partial response to prior chemotherapy at our hospital, were included. The primary outcome was the time from the end of previous platinum-based chemotherapy to disease progression (PFS). The Kaplan-Meier method was used to generate time-to-event curves for PFS; multivariate analysis was performed using the Cox proportional hazards regression model. RESULTS: The median PFS was 12 months (95% confidence interval [CI]: 8.3-15.8). Before olaparib administration, the median PFS was 12 months in the <4.1 neutrophil-to-lymphocyte ratio group and 4 months in the ≥4.1 group, with PFS being significantly better in the <4.1 group (log-rank: p = 0.023). When comparing serum cancer antigen 125 (CA125) levels, the median PFS was 13 months in the <18 U/mL group and 6 months in the >18 U/mL group (log-rank: p = 0.022). Multivariate Cox regression analysis revealed that CA125 was the factor affecting PFS (hazard ratio: 4.85; 95% CI: 1.53-15.38). CONCLUSIONS: Serum CA125 levels at olaparib initiation in patients with platinum-sensitive relapsed ovarian cancer may predict PFS as an effect of maintenance therapy using olaparib to treat recurrent disease.

Long-term survival differences between sevoflurane and propofol use in general anesthesia for gynecologic cancer surgery.

BACKGROUND: This study aimed to evaluate the influence of anesthetic management with propofol or sevoflurane on the prognosis of patients undergoing gynecologic cancer surgery. METHODS: This retrospective cohort study included patients who underwent gynecologic cancer (cervical, endometrial, and ovarian cancer) surgery between 2006 and 2018 at the National Hospital Organization Osaka National Hospital. Patients were grouped according to anesthesia type for maintenance of anesthesia: propofol or sevoflurane. After propensity score matching, Kaplan-Meier survival curves were constructed for overall survival, cancer-specific survival, and recurrence-free survival. Univariate and multivariate cox regression models were used to compare hazard ratios for recurrence-free survival. RESULTS: A total of 193 patients with propofol and 94 with sevoflurane anesthesia were eligible for analysis. After propensity score matching, 94 patients remained in each group. The sevoflurane group showed significantly lower survival rates than the propofol group with respect to 10-year overall survival (89.3% vs. 71.6%; p = 0.007), 10-year cancer-specific survival (91.0% vs 80.2%; p = 0.039), and 10-year recurrence-free survival (85.6% vs. 67.7%; p = 0.008). Sevoflurane anesthesia was identified as an independent risk factor for recurrence-free survival. Furthermore, distant recurrence was significantly more frequent in the sevoflurane group than in the propofol group (p < 0.001). CONCLUSION: In patients undergoing gynecologic cancer surgery, sevoflurane anesthesia was associated with worse overall, cancer-specific, and recurrence-free survival than propofol anesthesia.

Histologic grade and peritoneal cytology as prognostic factors in type 1 endometrial cancer.

BACKGROUND: Prognostic clinicopathological factors for type 1 endometrial cancer are unknown and the purpose of the current study was to determine the independent prognostic variables for type 1 endometrial cancer. METHODS: We performed a retrospective study of 168 patients with type 1 endometrial cancer primarily treated with comprehensive staging surgery. The median follow-up time was 68 (12-100) months. Independent risk factors for disease-free survival (DFS) and overall survival (OS) were determined using multivariate Cox regression models. Sub-group analysis of stage I was also performed. We also assessed the patterns of failure among patients with recurrences and investigated the associations with the prognostic variables determined by multivariate analysis. RESULTS: Twenty patients (11.9%) had recurrence and 13 patients (7.7%) died of the disease overall. Multivariate analysis revealed that grade 2 (G2) histology (p = 0.008) and positive peritoneal cytology (p = 0.001) predicted the recurrent event in type 1 endometrial cancer. G2 histology (p = 0.007) and positive peritoneal cytology (p = 0.003) were also found to be independent risk factors for tumor-related deaths. Among stage I patients, G2 histology and positive peritoneal cytology were also independent prognostic variables for DFS and OS. Patients with G2 histology and/or positive peritoneal cytology were more likely to have recurrence at distant sites. CONCLUSIONS: G2 histology and positive peritoneal cytology were independent prognostic factors for DFS and OS in type 1 endometrial cancer.

Utility of the maximum standardized uptake value on positron emission tomography for predicting therapeutic effect in recurrent gynecological malignancies: A preliminary study.

AIM: The maximum standardized uptake value (SUVmax) of primary tumors in positron emission tomography can be used to predict prognosis in various cancers, but its significance in recurrent tumors remains unclear. In the present study, we evaluated the utility of the SUVmax for predicting therapeutic effects in recurrent gynecological malignancies. METHODS: From February 2012 to July 2014, patients with recurrent gynecological cancer who were treated with chemotherapy or radiotherapy were enrolled in this study. The SUVmax of recurrent lesions before treatment were compared to the therapeutic effects. RESULTS: Fifty patients with recurrent gynecological cancer were enrolled. The mean SUVmax was significantly higher in patients with stable disease/progressive disease than in patients who achieved complete remission/partial remission (13.24 ± 9.78 vs 8.61 ± 5.34, P = 0.039). In patients who were administered chemotherapy, the SUVmax was significantly higher in those with stable disease/progressive disease than in those who achieved complete remission/partial remission (13.24 ± 9.78 vs 8.61 ± 5.34, P = 0.0392) as well as those administered radiotherapy or concurrent chemoradiation therapy (18.15 ± 3.25 vs 11.33 ± 3.98, P = 0.0073). In ovarian cancer patients administered chemotherapy, when the cut-off value of the SUVmax was set as 6.94, the sensitivity and specificity of predicting therapeutic effects were 0.75 and 0.846, respectively. CONCLUSION: Although the number of enrolled cases was small, our study revealed that the SUVmax in recurrent gynecological tumors might predict therapeutic effects. If the SUVmax is relatively high, multimodal therapy, including surgical removal, should be considered.

[Continuous Interstitial Subcutaneous Fluid Glucose (ISFG) Measurement during Pre- and Intraoperative Periods for Highly Invasive Surgery].

BACKGROUND: Recently ERAS protocol has become common, and patients in our hospital drink preoperative oral fluid with carbohydrate nutrition. The present study evaluates interstitial subcutaneous fluid glucose (ISFG) with CGMS-Gold and ISFG variability is relevant to oral fluid. METHODS: The data was ISFG measurement with CGMS-Gold from 29 patients undergoing esophagus operation, liver resection, and pancreaticoduodenectomy in September 2011 to September 2012. We divided them into two groups. One was "preoperative (from having oral fluid to entering room) high ISFG group (H group : 11)" which showed preoperative peak ISFG over 200 mg x dl(-1). The other was "preoperative low ISFG group (N group: 18)" which showed preoperative peak ISFG under 200 mg x dl(-1). We compared preoperative and intraoperative (from entering to leaving room) peak ISFG in these groups. RESULTS: Preoperative peak ISFG was 267 ± 55 mg x dl(-1) in H group and 161 ± 16 mg x dl(-1) in N group. Intraoperative peak ISFG was 231 ± 75 mg x dl(-1) in H group and intraoperative peak ISFG was over 180 mg x dl(-1) in 9 patients. Intraoperative peak ISFG was 177 ± 50 mg x dl(-1) in N group and intraoperative peak ISFG was over 180 mg x dl(-1) in 7 patients. Preoperative high ISFG patients tended to show intraoperative high ISFG (P = 0.052); 6 patients were with diabetes mellitus and all the patients had pre- and intraoperative high ISFG. Thirteen patients without diabetes mellitus didn't show intraoperative high ISFG. CONCLUSIONS: This study suggested preoperative high ISFG group tended to show intraoperative high ISFG.

[A Multicenter Questionnaire Survey of Postoperative Delirium -National Hospital Organization, Surgery and Anesthesia Network Group-].

BACKGROUND: Postoperative delirium in the elderly is associated with increased morbidity and risk of injury. However, the opinion of attending surgeons and anes- thesiologists regarding postoperative delirium is uncer- tain, as is the prevention and treatment of the condi- tion, in Japanese hospitals. METHODS: We conducted a multicenter questionnaire survey about postoperative delirium. Survey sheets were sent to 40 hospitals belonging to the National Hospital Organization. RESULTS: Wide variation in the answers from 26 hospitals revealed no common understanding regarding the diagnosis and management of postoperative delir- ium. The incidence of postoperative delirium was reported as 20-30%. It developed on postoperative day 2, with recovery within 1 month. Age, postoperative complications, alcohol abuse, cognitive impairment, sex, and depth of anesthesia were considered to be risk fac- tors. Prevention and treatment strategies included pain control, encouraging normal sleep-wake cycles, and avoiding postoperative complications. Although phar- macologic management with haloperidol or risperidone was also adopted in many facilities, the effect was thought to be uncertain. All respondents agreed that an enormous effort was required in caring for patients with postoperative delirium. CONCLUSIONS: Prospective clinical studies are neces- sary for improving the management of elderly patients with postoperative delirium.

Uterine cervical cancer with brain metastasis as the initial site of presentation.

Brain metastasis from uterine cervical cancer is rare, with an incidence of 0.5%, and usually occurs late in the course of the disease. We report a case of uterine cervical cancer with brain metastasis as the initial site of presentation. A 50-year-old woman with headache, vertigo, amnesia and loss of appetite was admitted for persistent vomiting. Contrast enhanced computed tomography showed a solitary right frontal cerebral lesion with ring enhancement and uterine cervical tumor. She was diagnosed with uterine cervical squamous cell carcinoma with parametrium invasion and no other distant affected organs were detected. The cerebral lesion was surgically removed and pathologically proved to be metastasis of uterine cervical squamous cell carcinoma. The patient underwent concurrent chemoradiotherapy, followed by cerebral radiation therapy, but multiple metastases to the liver and lung developed and the patient died 7 months after diagnosis of brain metastasis.

[Perioperative Management of a Patient with Hereditary Angioedema: A Case Report].

Hereditary angioedema (HAE) is a very rare disease that occurs in about 1 in 50,000 to 150,000 people. HAE is caused by low levels or inproper function of the plasma protein C1 inhibitor (C1-INH) which regulates activation of the complement system and the coagulation system. The typical symptom of HAE is regional swellings without pain nor itching, usually triggered by physical trauma or emotional stress. Unlike allergic edema, HAE attacks do not respond to antihistamines, corticosteroids noradrenaline. The swelling attacks against face and throat are potentially life-threatening, and should be treated as a medical emergency. We report a patient with HAE who underwent radical cystectomy of the upper gum under general anesthesia. Because the oral surgery with tracheal intubation is known to be a risk factor of laryngeal edema in a patient with HAE, she was given C1-INH before operation to prevent laryngeal edema according to HAE Guideline 2010 by the Japanese Association for Complement Research. Her pharynx and larynx were checked with Airwayscope before intubation and with bronchofiberscope before extubation, but no edema was recognized. Postoperatively, she was given C1-INH on the next morning again. She was discharged seven days after operation without any complications.

[Comparison of the Pressure on the Larynx and Tongue Using McGRATH® MAC Video Laryngoscope--Direct Vision versus Indirect Vision].

BACKGROUND: Studies show that McGRATH® MAC (McG) is useful during direct laryngoscopy. However, no study has examined whether McG re- duces pressure on the upper airway tract We compared direct vision with indirect vision concerning pressure on the larynx and tongue. METHODS: Twenty two anesthesiologists and 16 junior residents attempted direct laryngoscopy of airway management simulator using McG with direct vision and indirect vision. Pressure was measured using pressure measurement film. RESULTS: In anesthesiologists group, pressure on larynx was 14.8 ± 2.7 kgf · cm(-2) with direct vision and 12.7 ± 2.7 kgf · cm(-2) with indirect vision (P < 0.05). Pressure on the tongue was 8.8 ± 3.2 kgf cm(-2) with direct vision and 7.6 ± 2.8 kgf · cm(-2) with indirect vision (P = 0.18). In junior residents group, pressure on larynx was 19.0 ± 1.3 kgf · cm(-2) with direct vision and 14.1 ± 3.1 kgf · cm(-2) with indirect vision (P < 0.05). Pressure on the tongue was 15.4 ± 3.6 kgf · cm(-2) with direct vision and 11.2 ± 4.7 kgf · cm(-2) with indirect vision (P < 0.05). CONCLUSIONS: McG with indirect vision can reduce pressure on the upper airway tract.

Preoperative evaluation of deep venous thrombosis in patients with pelvic organ prolapse.

AIM: The incidence of preoperative deep venous thrombosis (DVT) was examined in patients with pelvic organ prolapse (POP). MATERIAL AND METHODS: Preoperative screening for DVT was performed on the basis of D-dimer levels; if D-dimer levels were beyond the cut-off limit (0.5 µg/mL), ultrasound examination of the lower extremities was performed. A total of 75 consecutive patients who were scheduled for POP operation in our department were examined retrospectively. RESULTS: D-dimer levels were elevated in 24 patients (31.6%). Further, DVT was detected in 10 of the 75 patients, resulting in an incidence rate of 13.3% in the present study. D-dimer levels were significantly higher in the patients with DVT (1.25 ± 0.52 µg/mL vs 0.41 ± 0.26 µg/mL). There was no significant difference in age, and although body mass index and the number of diabetes mellitus cases were relatively higher in the patients with DVT than in those without DVT, there were no statistically significant differences. According to a receiver-operator curve, the suggested cut-off D-dimer value was 0.71 µg/mL (sensitivity and specificity was 0.9 and 0.877, respectively). CONCLUSIONS: Although this was a preliminary study, to the best of our knowledge, this is the first report describing the incidence of preoperative DVT in patients with POP. Our study indicates that the incidence of DVT in patients with POP might have been underestimated thus far. Therefore, every surgeon should evaluate patients for DVT prior to any surgical procedure for POP, particularly in those patients with obesity or diabetes mellitus.

Primary retroperitoneal Müllerian adenocarcinoma arising from endometriosis.

Primary retroperitoneal Müllerian adenocarcinoma (PRMA) is an extremely rare tumor and the cause remains unknown. We report a case of PRMA arising from endometriosis. A 52-year-old woman with a history of malignant lymphoma underwent a follow-up computed tomography scan, which revealed a retroperitoneal tumor. Immunohistochemical analysis of tumor resected during laparoscopic surgery showed adenocarcinoma positive for cytokeratin 7 and negative for cytokeratin 20. The patient had undergone hysterectomy and bilateral salpingo-oophorectomy 14 years ago for myoma uteri and endometrial cysts and was treated with estrogen-replacement therapy. The size of the tumor increased and laparotomy was performed. Histopathological examination showed adenocarcinoma resembling endometrial adenocarcinoma, which stained positive for cancer antigen 125, cancer antigen 19-9, estrogen receptor, and progesterone receptor immunohistochemically. The focus of the endometriosis was found at the edge of the tumor, and the stromal cells around the tumor cells were CD10 positive. The patient was diagnosed as having PRMA arising from endometriosis, and treated with adjuvant chemotherapy.

[Retrospective analysis of perioperative cardiovascular complications in patients with low left ventricular function undergoing noncardiac surgery].

BACKGROUND: Regarding patients for noncardiac surgery with low left ventricular function, we have little information about perioperative cardiovascular complications, making it difficult to evaluate such patients preoperatively and to inform them of their perioperative course. METHODS: We retrospectively investigated the patients undergoing noncardiac surgery under general anesthesia in our hospital from January 2008 to December 2011. The subjects were 52 patients with low left ventricular function defined as left ventricular ejection fraction under 40%. Patients with perioperative complications were compared with those without them in about 14 factors which might influence their perioperative course. RESULTS: Only one patient had severe hypotension intraoperatively. Postoperatively, five patients had cardiovascular complications in a week and three more in a month. Compared with those with complications and those without them, significant differences were found in 3 of 14 factors : type of surgery (P = 0.006), operation time (P = 0.013), and amount of intraoperative transfusion (P = 0.039). CONCLUSIONS: Regarding patients for noncardiac surgery with low left ventricular function, high risk of perioperative cardiovascular complications was found in a surgery which is highly invasive, long lasting, or requiring massive transfusion.

[Effects of preoperative oral carbohydrate administration on gastric contents].

BACKGROUND: Preoperative oral carbohydrate administration for adult patients has been recommended by European Society for Parenteral and Enteral Nutrition and Enhanced Recovery After Surgery. Although preoperative oral carbohydrate may improve patient satisfaction and perioperative glucose metabolism, its effects on the gastric contents remain controversial. METHODS: We included 232 adult patients without gastrointestinal stenosis or occlusion. Seventy-four patients (group A) were not permitted to eat or drink before operation for eight hours, while 158 patients (group B) took oral carbohydrate (225 ml, 22.3% glucose) two hours before anesthesia induction. After induction, gastric contents were aspirated to examine its volume and pH. RESULTS: Although the mean volume of gastric contents of the patients in group B was significantly lower than that in group A, and gastric pH was also significantly smaller in group B, no patients suffered from aspiration during rapid induction. Fasting interval and gastric volume were inversely related, and almost all the patients with fasting interval above 150 minutes showed gastric contents volume smaller than 25 ml and gastric pH more than 2.5. CONCLUSIONS: We conclude that preoperative oral carbohydrate can be given safely, although the fasting interval should be 150 minutes in our diet regimen.

Polymerization of insulin-like growth factor-binding protein-1 (IGFBP-1) potentiates IGF-I actions in placenta.

Insulin-like growth factor (IGF)-binding protein-1 (IGFBP-1), the main secretory protein of decidua that binds to IGFs and has been shown to inhibit or stimulate IGFs' bioactivities. Polymerization, one of the posttranslational modifications of IGFBP-1, has been shown to lead to loss of inhibiting effect of IGFBP-1 on IGF-I actions. The current studies were undertaken to elucidate the effects of steroid hormones on IGFBP-1 polymerization in trophoblast cell cultures. Placental tissues were obtained during legal, elective procedures of termination of pregnancy performed between 7 and 10 weeks of gestation, and primary trophoblast cells were separated. IGFBP-1 polymerization was analyzed by SDS-PAGE and immunoblotting. IGFBP-1 was polymerized when IGFBP-1 was added to trophoblast cell cultures. Polymerization of IGFBP-1 was inhibited by the addition of anti-tissue transglutaminase antibody into the culture media. There was an increase in the intensity of polymerized IGFBP-1 bands with the addition of medroxyprogesterone acetate (MPA), while no such difference was observed upon treatment with estradiol. MPA also increased the expression of tissue transglutaminase on trophoblast cell membranes. IGF-I stimulated trophoblast cell migration, while IGFBP-1 inhibited this IGF-I-induced trophoblast response. Addition of MPA attenuated the inhibitory effects of IGFBP-1 on IGF-I-induced trophoblast cell migration. IGFBP-1 was polymerized by tissue transglutaminase on the cell surface of trophoblasts, and MPA increased tissue transglutaminase expression on the cell surface and facilitated IGFBP-1 polymerization. These results suggest that progesterone might facilitate polymerization of decidua-secreted IGFBP-1 and increase IGF-I actions at feto-maternal interface, thereby stimulating trophoblast invasion of maternal uterus.

[Perioperative management for a case of carotid artery stenting].

A 70-year-old male patient with severe cardiac dysfunction underwent carotid artery stenting for severe left carotid artery stenosis under monitored anesthetic care. He was sedated with propofol and fentanyl, and was monitored with ECG, pulse-oximeter and direct blood pressure measurement. He breathed spontaneously without severe hypoxia during the procedure. Followed by insertion of transient ventricular pacing wire against expected severe bradycardia, a guidewire was introduced into left internal carotid artery lesion via the right femoral artery. Soon after dilating the stenotic portion with a ballon catheter, sudden hypotension and bradycardia were recognized, which were successfully managed with bolus injections of vasoconstrictors and atropine sulphate. Even after stenting, hypotension continued for two days in spite of continuous administration of dopamine. Postoperative examination showed that the blood flow of the left carotid artery was doubled. Two weeks after the operation, he was discharged uneventfully.

Longer time to extubation after general anesthesia with desflurane in patients with obstructive respiratory dysfunction: a retrospective study.

BACKGROUND: The prospect of patients with obstructive respiratory dysfunction undergoing surgery has increased with the growth in the elderly population; however, there have been few investigations about the recovery profile from volatile anesthesia. This study aimed to investigate the impact of obstructive respiratory dysfunction on recovery from desflurane anesthesia. METHODS: A retrospective cohort study included patients who underwent orthopedic lower limb surgery between September 2018 and March 2020. Patients were divided into two groups: those whose preoperative forced expiratory volume in 1 s/forced vital capacity ratio was <70% (obstructive respiratory dysfunction group, n = 180) or ≥70% (control group, n = 45). Time from discontinuation of desflurane to extubation (extubation time) was compared between the two groups. Univariate and multivariable Cox regression models were used to compare odds ratios for prolonged extubation (≥10 min). RESULTS: A total of 45 patients with obstructive respiratory dysfunction and 180 control patients were eligible for analysis. Extubation time was significantly longer in patients in the obstructive respiratory dysfunction group than those in the control group. In the multivariable Cox model, male sex (HR = 2.00, 95% CI 1.12-3.57; P = 0.020) and obstructive respiratory dysfunction (HR = 2.07, 95% CI 1.05-4.08; P = 0.036) were associated with prolonged extubation. CONCLUSIONS: This retrospective study indicated that extubation time was longer in patients with obstructive respiratory function than in patients without obstructive respiratory function. Male sex and obstructive respiratory function were factors that contributed to extubation time.

A Case of Metastatic Uterine Tumor Originating from Small-Cell Lung Cancer (SCLC) Mimicking Uterine Sarcoma.

Metastatic uterine tumors originating from extragenital cancers are a rare clinical occurrence. We report a case of metastatic uterine cancer derived from small-cell lung cancer (SCLC) that necessitated surgical treatment. The patient was a 59 y/o female who had undergone chemotherapy for stage IIIB SCLC. A 15 cm uterine tumor lesion was initially detected on CT scans. The patient had previously been diagnosed with uterine fibroids, but compared to the most recent CT scans taken one and a half months earlier, imaging diagnosis revealed a sudden increase in the size of the tumor when compared to the 8 cm myoma fibroid noted previously. Additional work-up with MRI scans revealed T2-enhanced images of a tumor that had almost completely invaded the myometrium; the tumor presented with marked diffusion-weighted enhancement, and a flow void was noted within the tumor. A differential diagnosis of uterine sarcoma was considered, but due to the lack of focal hemorrhage or necrosis findings on MRI imaging, the possibility of differential diagnosis of metastatic SCLC was also noted. As the patient was experiencing abdominal symptoms including abdominal distension and tenderness due the tumor, a simple hysterectomy and bilateral salpingo-oophorectomy were performed to palliate the symptoms. During the surgical procedures, intra-abdominal findings noted peritoneal dissemination while intraoperative cell cytology diagnosis of ascites revealed small-cell cancer. The final histopathological diagnosis likewise revealed metastatic small-cell cancer from the primary lung cancer. The clinical status of the lung cancer was evaluated as progressive disease (PD), and a change in chemotherapy regimen was necessitated. Further disease progression was noted on CT scans at 2 and a half months after surgery, and with gradual systemic disease progression, the patient died of disease at 3 months postsurgery. Initial evaluation of rapidly enlarging uterine tumors should include a differential diagnosis of uterine sarcoma; additionally, it is necessary to also consider the rare possibility of metastatic disease as in the present case with a clinical history of extragenital malignancy.

Increase in Intraoperative Urine Output During Tympanoplasty: A Retrospective Cohort Study.

OBJECTIVE: We sometimes encounter cases with unexpected increase in intraoperative urine output during tympanoplasty. However, no previous study has evaluated whether intraoperative urine output during tympanoplasty is higher than that during other surgeries. Thus, this study aimed to evaluate the association between tympanoplasty and intraoperative urine output. METHODS: This single-center retrospective cohort study was conducted by assessing the records of patients who underwent tympanoplasty, sinus surgery, or thyroidectomy under general anesthesia between April 2013 and March 2017. We defined intraoperative polyuria as a urine output rate of ≥ 2.5 mL/kg/h. The factors associated with high urine output were investigated using multivariable analysis. The influence of tympanoplasty on intraoperative urine output was evaluated after propensity score matching that excluded confounding factors, except the surgical procedure. RESULTS: Intraoperative polyuria occurred in 48 of 173 patients (27.7%) who underwent tympanoplasty. Multivariable analysis revealed that tympanoplasty (p = 0.001), operative time of ≥ 3 h (p = 0.010), and fluid infusion volume of ≥ 5 mL/kg/h (p = 0.029) were risk factors for polyuria. Among the study patients, 100 who underwent tympanoplasty (tympanoplasty group) and 100 who underwent sinus surgery or thyroidectomy (control group) were matched by propensity score analysis. The intraoperative urine output rate was significantly higher in the tympanoplasty group than in the control group (1.2 [0.51-2.20] mL/kg/h vs. 0.70 [0.32-1.60] mL/kg/h, p = 0.010). CONCLUSION: Our findings indicate that intraoperative urine output is higher during tympanoplasty than that during other otologic surgeries.

Intracranial infiltration by recurrent scalp dermatofibrosarcoma protuberans.

Dermatofibrosarcoma protuberans (DFSP) of the scalp is a rare soft tissue sarcoma. A 22-year-old male with DFSP, who had undergone several surgical excisions and radiotherapy, presented with a mild left lower-limb paresis. An MRI scan demonstrated a huge mass extending throughout the frontoparietal convexity. A macroscopically complete removal of the mass was performed. Despite this, there were several recurrences; thereafter, the patient underwent surgery, stereotactic radiosurgery and chemotherapy. The histological findings demonstrated a DFSP that both abutted and occasionally invaded the adjacent brain cortex, while extending along the Virchow-Robin spaces. Due to the highly infiltrating characteristics of DFSP, another approach, such as the use of molecular-targeted agents, will be required to significantly improve the clinical outcome.

[Comparison of Cormack/Lehane classification grades decided by novice residents and those by board certified anesthesiologists].

BACKGROUND: Tracheal intubation training is one of the most important ones in anesthesia training. But it is difficult to evaluate from the outside whether the laryngeal view obtained with the laryngoscope is appropriate or not. METHODS: We chose a total of 389 cases of tracheal intubation performed by 12 novice residents in 2 months, and compared the grades of Cormack/Lehane classification of the same patients decided by novice residents and board certified anesthesiologists. RESULTS: During the 2-month period, the average number of tracheal intubation performed by a novice resident was 32 +/- 12 cases (mean +/- SD). A significant difference was found between Cormack/Lehane classification (P<0.05) decided by novice residents and those by board certified anesthesiologists. When the number of intubation performed by a novice resident was fewer than 30, the grade was grade II > III > I > IV. On the contrary, when it was more than 30, the ratio of grades I and II (appropriate laryngeal view) increased and the distribution changed to grade II > I >III > IV. CONCLUSIONS: We considered it useful in the tracheal intubation training that certified anesthesiologists evaluate patients' Cormack/Lehane classification grades before novice residents do, because we can obtain necessary information on laryngeal view and intubation difficulty in advance.