Difficult airway associated with bifid glottis and coexistent subglottic stenosis in a patient with Pallister-Hall syndrome: a case report.

BACKGROUND: Pallister-Hall syndrome is a rare disorder characterized by hypothalamic hamartoma, hypopituitarism, bifid epiglottis, and micrognathia. CASE PRESENTATION: We describe the airway management under general anesthesia of a 15-year-old female with Pallister-Hall syndrome whose airway was compromised with bifid epiglottis and acquired subglottic stenosis. The three options considered for airway management were tracheal intubation, a supraglottic device, and surgical tracheotomy. Tracheal intubation provides a secured airway, but extubation can be difficult. A supraglottic device minimizes airway injury, but it does not completely protect the airway from aspiration. CONCLUSIONS: The patient's airway was successfully managed using a supraglottic device with aspiration prophylaxis. Airway management devices should be selected according to each patients' individual circumstances.

Unsuccessful tracheal intubation in a patient with Kniest dysplasia undergoing repeated general anesthesia: a case report.

BACKGROUND: Kniest dysplasia is a type of chondrodysplasia characterized by severe craniofacial abnormalities including tracheomalacia, midface hypoplasia, and cleft palate. CASE PRESENTATION: We previously described a 6-year-old girl with Kniest dysplasia, in whom glottic edema rapidly developed after tracheal intubation. At the age of 13 years, a reoperation was scheduled to correct talipes equinovarus but was subsequently canceled due to failure of tracheal intubation and subsequent glottic edema. Airway evaluation by endoscopy and computed tomography 1 month later revealed severe laryngeal narrowing. Therefore, the second anesthesia was maintained with spinal anesthesia combined with sciatic nerve block without tracheal intubation. CONCLUSION: Careful perioperative airway evaluation is required in patients with Kniest dysplasia, and alternative strategies for airway management other than tracheal intubation should be considered.

Simple and efficient isolation of cordycepin from culture broth of a Cordyceps militaris mutant.

Isolation of cordycepin from the culture broth of Cordyceps militaris mutant was investigated. Based on the solubility curve, three crystallizing processes, temperature shift (process I), pH shift (process II), and pH shift followed by temperature shift (process III) were carried out. Process III was the most promising method regarding both purity and yield.

Management of general anesthesia in a child with Miller-Dieker syndrome: a case report.

Miller-Dieker syndrome (MDS) is a rare disorder characterized by type I lissencephaly and a distinctive facial appearance that may include prominent forehead, bitemporal hollowing, and micrognathia. MDS is associated with epilepsy. We here report an 18-month-old girl with MDS who required general anesthesia. The child had an extremely low Bispectral Index (BIS) value prior to undergoing general anesthesia. Her perioperative course was uneventful. This case highlights some of the important anesthetic concerns in patients with MDS, which include potentially difficult airways and extremely low BIS values.

Impact of skin incision on the pleth variability index.

OBJECTIVE: The pleth variability index (PVI), which is calculated from respiratory variations in the perfusion index (PI), reportedly predicts fluid responsiveness. However, vasomotor tone fluctuations induced by nociceptive stimuli change the PI and may reduce the accuracy of PVI. The aim of this study was to confirm the effects of surgical stimuli on PVI. METHODS: Twenty-four patients were examined after the induction of general anesthesia. Heart rate (HR), mean arterial blood pressure (MBP), PI, PVI, stroke volume variation (SVV), and cardiac index (CI) were recorded before and after the skin incision. PI and PVI were calculated using a Radical 7 pulse oximeter, and SVV and CI were calculated using the FloTrac/Vigileo system. RESULTS: After the skin incision, the PI decreased significantly from 5.3 (4.0-6.2%) to 3.6% (1.8-4.7%), whereas the PVI increased significantly from 9.5 (7.0-12.0%) to 13.5% (9.0-16.0%). A significant negative correlation was observed between the changes in PI and PVI before and after the skin incision. The skin incision did not affect the HR, CI, or SVV but increased the MBP. CONCLUSION: This study showed a significant increase in the PVI and a negative correlation between the changes in PVI and PI before and after the skin incision. The PVI can be calculated from the variations in the PI caused not by mechanical ventilation, but rather by fluctuations in vasomotor tone. When using the PVI as an indicator for fluid responsiveness, it is crucial to pay attention to fluctuations in vasomotor tone induced by nociceptive stimuli.

Production of cordycepin by a repeated batch culture of a Cordyceps militaris mutant obtained by proton beam irradiation.

Cordycepin (3'-deoxyadenosine) is one of the most versatile metabolites of Cordyceps militaris due to its broad spectrum of biological activity. In our previous study, the C. militaris mutant G81-3, which produces higher levels of cordycepin, was obtained by high-energy proton beam irradiation. In this study, the effects of adenosine on cordycepin production in a surface liquid culture of the mutant and the wild type strains were investigated. For the mutant strain, the optimum dose of adenosine yielded a 30% increase in cordycepin production; the maximum levels of production with adenosine and without adenosine were 8.6g/l and 6.7 g/l, respectively. In contrast, the increase due to adenosine supplementation for the wild type strain was only 15% (3.1g/l with adenosine and 2.7 g/l without adenosine). Furthermore, a repeated batch culture, an efficient production method, was carried out to eliminate the relatively long lag phase of the mutant culture. Over four cycles, both the mutant and the wild type strain maintained a production level of more than 85% of that of the initial cycle. As a result, the disadvantage of the mutant was successfully overcome, resulting in a productivity (0.48 g/(ld)) higher than that of the batch culture (0.29 g/(ld)). The productivity for cordycepin obtained in this study is the highest reported value to date, and this method could be applied to large-scale production of cordycepin at industrial levels.

Medicinal uses of the mushroom Cordyceps militaris: current state and prospects.

Cordyceps militaris is a potential harbour of bio-metabolites for herbal drugs and evidences are available about its applications for revitalization of various systems of the body from ancient times. Amongst all the species, C. militaris is considered as the oldest source of some useful chemical constituents. Besides their popular applications for tonic medicine by the all stairs of the community, the constituents of C. militaris are now used extensively in modern systems of medicine. The current survey records the mysterious potentials of C. militaris are boosting up the present herbal treatments, as well as gearing up the green pharmacy revolution, in order to create a friendly environment with reasonable safety. Evidence showed that the active principles of C. militaris are beneficial to act as pro-sexual, anti-inflammatory, anti-oxidant/anti-aging, anti-tumour/anti-cancer/anti-leukemic, anti-proliferative, anti-metastatic, immunomodulatory, anti-microbial, anti-bacterial, anti-viral, anti-fungal, anti-protozoal, insecticidal, larvicidal, anti-fibrotic, steroidogenic, hypoglacaemic, hypolipidaemic, anti-angiogenetic, anti-diabetic, anti-HIV, anti-malarial, anti-fatigue, neuroprotective, liver-protective, reno-protective as well as pneumo-protective, let alone their other synergistic activities, which let it be marketable in the western countries as over-the-counter medicine. A number of culture techniques for this mushroom have been noticed, for example, storage/stock culture, pre-culture, popular/indigenous culture (spawn culture, husked rice culture and saw dust culture) and, special/laboratory culture (shaking culture, submerged culture, surface liquid culture and continuous/repeated batch culture). The prospects for herbal biotechnology regarding drug discovery using C. militaris delivering what it has promised are high, as the technology is now extremely more powerful than before. This study chiefly highlights the medicinal uses of the mushroom C. militaris including its culture techniques, also aiming to draw sufficient attention of the researchers to the frontier research needs in this context.

Novel mRNA molecules are induced in hypertrophied ventricles of carnitine-deficient mice and belong to a family of up-regulated gene in cells overexpressing c-erbB-2.

To clarify the pathogenesis of cardiac hypertrophy in carnitine-deficient juvenile visceral steatosis (JVS) mice, we performed differential mRNA display analysis with the ventricles of control and JVS mice. We found a novel up-regulated gene, designated as carnitine deficiency-associated gene expressed in ventricle (CDV)-3. Northern blot analysis with a cDNA probe derived from the novel gene revealed two substantial mRNA species of prominent 4.1- and faint 3.5-kb in examined tissues of control and JVS mice. In spite of their widely expressed features, up-regulation of the gene was found predominantly in the ventricles and slightly in the auricles and skeletal muscles of JVS mice. The up-regulation of CDV-3 gene in the ventricles of JVS mice was significantly relieved by carnitine administration within 6 h. The entire cDNA nucleotide sequences showed that two kinds of cDNA, long and short versions (CDV-3A and -3B), corresponding to the detected mRNAs, are different in a 711 base fragment. Analysis of genomic DNA revealed that the two mRNAs were derived from a single CDV-3 gene with five exons by alternative splicing. The deduced amino acid sequences indicated that the isoforms consist of 236 and 281 residues, differing at regions near the carboxy-terminus but sharing 231 residues of the amino-terminal regions. A BLAST search revealed that they show a high similarity to a human predicted nuclear protein (H41), which has been reported to be up-regulated in breast cancer cells overexpressing cellular-erythroblastosis B-2 (c-erbB-2, a kind of tyrosine kinase).We report the identification and characterization of novel transcripts that may be involved in the development of cardiac hypertrophy caused by carnitine deficiency.