Pathways of metastases from primary organs to the ovaries.

To investigate the metastatic pathways from the primary organs to the ovaries, we examined the microscopic findings from 18 original and 18 metastatic ovarian tumors carefully. In addition, we examined the immunohistochemical findings (Victoria blue stain for vascular invasion and D2-40 expression for lymphangio invasion) of metastatic ovarian tumors carefully. There were 4 (57%) ovarian lymphangio invasion cases in the 7 gastric cancers, but there were no cases in the 6 colorectal cancers (P < 0.05). There were 4 (67%) ovarian vascular invasion cases and one (17%) liver metastasis case in the 6 colorectal cancers, while there were no ovarian vascular invasions (P < 0.05) or no liver metastases in the 7 gastric cancers. The patients with metastatic ovarian tumors originating from distant organs who were treated at the same time as the original cancers had a significantly poorer prognosis than the patients with ovarian tumors treated later (P < 0.05). The rate of lymphatic metastasis from the stomach to the ovary was significantly higher than from the colon to the ovary. In addition we hypothesized that the rate of intravascular metastasis from the colorectum to the ovary was relatively higher than from the stomach to the ovary.

Retroperitoneal lipoma arising from the urinary bladder.

Retroperitoneal benign lipomas are extremely rare and represent about 2.9% of all primary retroperitoneal tumors. About 80% of the tumors in the retroperitoneal cavities are malignant neoplasms. We experienced a case of a retroperitoneal lipoma simulating an ovarian mature cystic teratoma. A diagnosis was correctly made by magnetic resonance imaging (MRI) prior to surgery, and a total tumorectomy was performed. The retroperitoneal lipoma was recognized to have arisen from the urinary bladder. Histological sections revealed a tumor consisting of typical adipose cells without atypia. These types of lipomas should be carefully followed-up because they often recur and undergo malignant transformations.

[General anesthesia for disabled patients undergoing dental treatment in a general hospital].

BACKGROUND: General anesthesia for dental treatment in disabled patients may present particular problems, especially when it is done in a general hospital, compared with specialized dental hospitals. METHODS: We surveyed 24 patients who underwent dental treatment under general anesthesia in our institution during the last decade. RESULTS: Electrocardiography or chest x-ray photography was not obtained in 8 patients owing to lack of patients' cooperation. Slow induction with sevoflurane was selected in 5 patients, because intravenous cannulae could not be placed owing to their rejection. Nasotracheal intubation was performed in all patients, but no difficulty in intubation was documented. As postoperative complications, we observed convulsion in one patient and muscle rigidity in another, but no critical troubles related to circulatory or respiratory status. In patients who were treated for more than ten teeth, we observed differences in age, body weight, duration of anesthesia, maximum concentration of sevoflurane administered during anesthesia, and use of postoperative analgesics compared with the other patients. CONCLUSIONS: We found particular problems of anesthesia for disable patients undergoing dental treatment in a general hospital, and suggest that information on numbers of teeth to be treated is helpful.

[Anesthetic experience for carotid endarterectomy in a patient with dilated cardiomyopathy under jugular venous oxygen saturation monitoring].

A 73-year-old male with dilated cardiomyopathy was scheduled for carotid endarterectomy. General anesthesia was administered with intravenous propofol and fentanyl. Cardiac output and jugular venous oxygen saturations were continuously monitored during the operation to maintain adequate cerebral circulation. The jugular venous oxygen saturation was maintained at above 85% during the operation. The patient recovered smoothly without any neurological sequelae.

[Surgical stress in perioperative period of combined off-pump coronary artery bypass grafting and abdominal aortic aneurysm repair].

OBJECTIVES: It is still controversial whether we should choose simultaneous operation or two-staged operation for patients who need both coronary artery bypass grafting (CABG) and abdominal aortic aneurysm (AAA) repair. Some reports suggest that combined CABG without cardiopulmonary bypass and AAA repair is less invasive than those with cardiopulmonary bypass. We estimated surgical stress of combined off pump CABG and AAA repair (CABG + AAA) in perioperative period compared with simple AAA repair retrospectively. METHODS: Seven patients (mean 60 years) underwent simultaneous operation of off pump CABG and AAA repair in our institution. We gathered data associated with circulatory, respiratory, renal function, recovery, and so on. We also examined postoperative complication and mortality. RESULTS: All parameters, except operation time and amount of catecholamine used, were not significantly different between the two groups. There were no operative mortality and only a slight morbidity in CABG + AAA. CONCLUSIONS: Our findings suggest that careful circulatory management with adequate transfusion and catecholamine use under precise monitoring is necessary during operation, but recovery after surgery, complication, and mortality in this combined operation are almost equivalent to those of simple AAA repair. We suggest that combined operation of CABG and AAA repair can be performed effectively.

Pulmonary Doppler flow velocity pattern during caudal epidural anaesthesia in children.

BACKGROUND: Haemodynamic effects of caudal anaesthesia in children have not been fully investigated. In the present study, we evaluated pulmonary haemodynamics during caudal anaesthesia in otherwise healthy children using Doppler-echocardiography. METHODS: Fifteen children undergoing elective lower abdominal surgery were randomly divided into two groups: nine children received 1.5% lidocaine and six physiological saline in the caudal epidural space. General anaesthesia was slowly induced and maintained using nitrous oxide and sevoflurane in oxygen. An epidural catheter was inserted into the caudal epidural space. Haemodynamic data including those with echocardiography were measured before and after epidural administration of lidocaine or saline. RESULTS: Mean blood pressure, end diastolic diameter of the left ventricle, ejection fraction of the left ventricle and mean velocity circumferential fibre shortening did not change in either group following caudal epidural block. Indices of pulmonary Doppler flow velocity, including peak velocity of pulmonary flow and acceleration-to-ejection time ratio, demonstrated a significant decrease after caudal lidocaine, but not after saline. CONCLUSIONS: Our data suggest that pulmonary Doppler flow velocity changes during caudal epidural anaesthesia, probably due to an increase in the pulmonary arterial resistance.

[Suddenly developing low output syndrome during acute thoracic aortic dissection surgery in a patient with progressive systemic sclerosis].

A 70-year-old man with progressive systemic sclerosis (PSS) suddenly developed low output syndrome (LOS) after weaning from cardiopulmonary bypass during acute thoracic aortic dissection and died in an early postoperative stage because of multiple organ failure. PSS was kept in a relatively good condition before onset of his surgical disease, but his Raynaud's phenomenon was much worse and inflammation findings were very severe before his operation. We suspected that PSS might have been involved in LOS in this case. PSS has many cardiac complications, for example spasm or organic changes of coronary artery, cardiac fibrosis, arrhythmia, secondary cardiac failure of pulmonary hypertension, pericardial inflammation, and so on, but we speculate that LOS might be caused by peripheral vessel disturbance. LOS occurs easily in chronic hypovolemic states and abnormal response of peripheral vessels due to PSS. We advise more careful anesthetic and circulatory management especially in invasive operation in PSS patients.