New diagnostic imaging of gastointestinal tumors: a preliminary study of three-dimensional tumor structure and volumetry.

BACKGROUND: The aim of the present report was to present preliminary results of the pre-operative evaluation of three-dimensional tumor structure and volumetry using three-dimensional computed tomography (3-D CT) and three-dimensional endoscopic ultrasonography (3-D EUS). MATERIALS AND METHODS: Diagnostic imaging was performed for 2 patients (one with gastric cancer, one with a rectal tumor) using virtual endoscopy, 3-D CT for the patient with gastric cancer and 3-D EUS for the patient with the rectal tumor, for the pre-operative evaluation of tumor structure and volumetry. Computer-generated image analysis of resected tumors was also performed. RESULTS: The gastric tumor was successfully visualized using 3-D CT and the rectal tumor was successfully visualized using 3-D EUS. The values obtained for volume of the stomach tumor, calculated using 3-D CT and resected materials, were 15.1 cm3 and 11.4 cm3, respectively. The values obtained for volume of the rectal tumor, calculated using 3-D EUS and resected materials, were 2.3 cm3 and 3.9 cm3, respectively. CONCLUSION: The present findings demonstrate that clinically useful results can be obtained by using 3-D CT and 3-D EUS for the pre-operative evaluation of 3-D tumor structure and volumetry of gastrointestinal tumors. We expect that further studies of these methods will lead to the establishment of new diagnostic criteria for gastrointestinal tumors based on tumor volume in the near future.

[Anesthetic management for removal of pheochromocytoma in a patient after repair of tetralogy of Fallot].

A 45-year-old woman after repair of tetralogy of Fallot at the age of 19, was admitted to the hospital for treatment of paroxysmal hypertension. She was diagnosed with pheochromocytoma of the left adrenal gland, and was scheduled for removal of pheochromocytoma. She received doxazosin for preoperative preparation. Anesthesia was induced with propofol and vecuronium, and maintained with intermittent fentanyl and sevoflurane in nitrous oxide and oxygen. Before induction of anesthesia, magnesium sulfate 40 mg x kg(-1) was injected, and followed by continuous infusion of 40 mg x kg(-1) x hr(-1) until the removal of pheochromocytoma. Under neuromuscular monitoring, vecuronium was administered prudently. Cardiac output was continuously monitored with pulmonary arterial catheter and transesophageal aortic blood flow monitor. Blood pressure and heart rate were stable even though the tumor was handled, and no additional vasodilator therapy was needed. After surgery, prolonged neuromuscular blockade caused by magnesium sulfate was not observed. We consider that successful management was feasible by administration of magnesium sulfate and preoperative administration of alpha1 blocker, under adequate perioperative monitoring.

[Airway obstruction in a patient using a cuff button-like silicone cannula for tracheal stoma].

We described a case of postoperative airway obstruction in a patient using a cuff button-like silicone cannula for tracheal stoma. A 59-year-old woman with rheumatoid arthritis, was admitted to the hospital for total knee arthroplasty. She had been managed by a long-term tracheostomy for rheumatic cricoarytenoid arthritis. Preoperative examination revealed no cardiopulmonary compromise. The surgery was performed under combined spinal-epidural anesthesia without any respiratory problems. Fifteen hours after surgery, she complained of dyspnea. Her oxygen saturation by pulse oximeter was 22-28%. We immediately removed the silicone cannula and inserted a tracheostomy tube. Her condition was dramatically improved next few minutes after the insertion. There were no dyskinesia and neurological disorders. We considered that airway obstruction occurred with the inadequate position of the cuff button-like silicone cannula, attached to the posterior wall of the trachea, sputum augmenting the obstruction.

Active hepatic capsulitis caused by Paragonimus westermani infection.

Paragonimiasis is an important re-emerging parasitosis in Japan. Although the lungs and pleural cavity are the principal sites affected with the parasite, ectopic infection can occur in unexpected sites such as skin and brain. This case report describes a patient with active hepatic capsulitis due to Paragonimus westermani infection. The patient was successfully treated with praziquantel at the dose of 75 mg/kg/day for 3 days.