Perioperative Use of Intravenous Levodopa as an Anti-Parkinsonian Drug: A Propensity Score Analysis.

Background: Perioperative discontinuation of oral anti-parkinsonian medication can negatively impact the prognosis of abdominal surgery in patients with Parkinson's disease. Although intravenous levodopa may be an alternative, its efficacy has not yet been investigated. Objectives: To determine the efficacy of intravenous levodopa as an alternative to oral anti-Parkinsonian drugs during gastric or colorectal cancer surgery. Methods: We identified patients with Parkinson's disease who underwent surgery for gastric or colorectal cancer between April 2010 and March 2020, using the Diagnosis Procedure Combination database, a nationwide inpatient database in Japan. Patients were divided into two groups: those who received intravenous levodopa during the perioperative period and those who did not. We compared in-hospital mortalities, major complications, and postoperative length of stay between the groups after adjusting for background characteristics with overlap weights based on propensity scores. Results: We identified 648 patients who received intravenous levodopa and 1207 who did not receive levodopa during the perioperative period. In the adjusted cohort, the mean postoperative length of stay was 24.7 and 29.0 days (percent difference, -7.7%; 95% confidence interval, -13.1 to -1.5); in-hospital death was 3.2% and 3.3% (adjusted odds ratio, 0.95; 95% CI: 0.54-1.67); and incidence of major complications were 21.4% and 19.3% (adjusted odds ratio, 0.89; 95% confidence interval, 0.70-1.13) in those with and without intravenous levodopa, respectively. Conclusions: Intravenous levodopa was associated with a shorter postoperative length of stay, but not with mortality or morbidity. Intravenous levodopa may improve perioperative care in patients with Parkinson's disease.

X-linked Agammaglobulinemia Diagnosed Following Bezold's Abscess: A Case Report.

Bezold's abscess is an extracranial complication of otitis media, in which a cervical abscess forms from the mastoid process through an ostial fistula, and is a rare condition in recent years. In this study, we experienced a X-linked agammaglobulinemia, which was discovered due to Bezold's abscess. Case: A 12-year-old boy suffering from recurrent right suppurative otitis media for three months was treated with tympanostomy and oral antibacterial therapy at a local otorhinolaryngology clinic. The patient visited the clinic due to a recurrence of symptoms. CT showed bony defects in the cortical bone and mastoid process of the lateral side of the right mastoid cell. The patient was referred to our hospital, admitted the same day and underwent emergency surgery. Intraoperative findings led to the diagnosis of acute mastoiditis and Bezold's abscess c aused b y mastoiditis spreading to the s ternocleidomastoid muscle. After drainage and administration of ABPC/SBT, the abscess disappeared, and the patient's general condition improved. Subsequently, a blood typing test performed on admission suggested the influence of low immunoglobulin levels. A close examination by the pediatric department led to a diagnosis of X-linked agammaglobulinemia. As a result, the patient receives regular immunoglobulin therapy and has been free of infection, including Bezold's abscess. CONCLUSIONS: In the case of recurrent otitis media and rare infections, congenital immune abnormalities should be considered.

A Case of Intratemporal Rhabdomyosarcoma in a Child Presenting with VIIth, IXth, and Xth Cranial Nerve Paralysis.

OBJECTIVE: Rhabdomyosarcoma is the most common soft tissue tumor in children, with average age of onset being 5 years, and approximately 70% cases diagnosed below 10 years of age. It accounts for 37% of primary head and neck malignancies in children. Chemotherapy with surgery, and radiation is selected as the primary treatment. We report a rare case of rhabdomyosarcoma in the temporal bone presenting with glossopharyngeal and vagus nerve paralysis as well as facial palsy. CASE REPORT: The patient was a 6-year-old boy, and his initial symptom was dizziness followed by facial palsy and hoarseness. Although a severe type of otitis media was suspected in the first clinic, CT and MRI showed a temporal bone tumor with parameningeal extension. Biopsy with cortical mastoidectomy revealed an embryonal-type rhabdomyosarcoma. Pretreatment re-excision was abandoned because of parameningeal involvement. The tumor disappeared after a series of chemotherapy, however, meningeal dissemination occurred, and he eventually died even after an additional administration of anti-cancer agents and intensive modulated radiation therapy. CONCLUSION: In the case of facial palsy concomitant with other cranial nerve paralysis, care must be taken into neoplastic origin. Early image diagnosis may offer a chance of complete resection in addition to chemoradiotherapy.

Outcomes of gastrointestinal cancer surgeries in Parkinson's disease patients: A nationwide study.

BACKGROUND: Parkinson's disease (PD) patients with comorbid cancers are increasing in aging populations. However, little is known about the impact of PD on the outcomes of surgeries to resect these cancers. We sought to clarify the association between PD and discharge status of patients who underwent surgery for gastrointestinal cancers, as the most prevalent malignant neoplasms worldwide. METHODS: We identified patients who underwent surgery for gastric and colorectal cancers between April 01, 2014 and March 31, 2018 using the Diagnosis Procedure Combination database, a nationwide administrative inpatient database in Japan. We then collected data on their sex, age, smoking status, body mass index, activities of daily living, cancer stage, and comorbidities. Multivariable Cox regression analyses were conducted to determine factors that influenced discharge to home. RESULTS: Compared with non-PD patients (n = 272,668), PD patients (n = 1341) were significantly older and less likely to receive laparoscopic surgery, and had lower body mass index, more advanced cancer stage, and lower activities of daily living. The proportions of PD and non-PD patients discharged to home were 80.3% and 96.2%, respectively. The adjusted hazard ratio for discharge to home for PD patients was 0.68 (95% confidence interval, 0.64-0.73; P < 0.001). CONCLUSIONS: Compared with non-PD patients, PD patients were less likely to be discharged to home after surgery for gastrointestinal cancers. The present results may indicate a necessity to improve perioperative care for patients with PD.

Immunohistochemical Marker Expression in Temporal Bone Squamous Cell Carcinoma.

BACKGROUND: The correlation between genomic mutations (or the overexpression of abnormal proteins) and prognosis in temporal bone squamous cell carcinoma (TBSCC) is not clear. We investigated the overexpression of EGFR and p53 as a pathological biomarker for predicting the clinical course of patients with TBSCC. METHODS: We performed a retrospective review of 22 TBSCC cases treated in Tokai University Hospital between January 2005 and October 2016. We assessed the overexpression of EGFR and p53 in TBSCC patients through immunohistochemical staining. We also evaluated the association between the overexpression of these proteins and clinicopathological variables, including survival outcomes. RESULTS: The primary lesion in all patients was the external auditory canal. Nine (40.9%) patients were EGFR positive, and 9 (40.9%) were p53 positive. The 5-year overall survival rate for EGFR-positive patients (55.6%) was significantly lower (p = 0.043) than that of the EGFR-negative patients (92.3%). CONCLUSION: EGFR overexpression in TBSCC patients may be a prognostic biomarker.

Clinical efficacy of haematopoietic stem cell transplantation for adult adrenoleukodystrophy.

Accumulated experience supports the efficacy of allogenic haematopoietic stem cell transplantation in arresting the progression of childhood-onset cerebral form of adrenoleukodystrophy in early stages. For adulthood-onset cerebral form of adrenoleukodystrophy, however, there have been only a few reports on haematopoietic stem cell transplantation and the clinical efficacy and safety of that for adulthood-onset cerebral form of adrenoleukodystrophy remain to be established. To evaluate the clinical efficacy and safety of haematopoietic stem cell transplantation, we conducted haematopoietic stem cell transplantation on 12 patients with adolescent-/adult-onset cerebral form/cerebello-brainstem form of adrenoleukodystrophy in a single-institution-based prospective study. Through careful prospective follow-up of 45 male adrenoleukodystrophy patients, we aimed to enrol patients with adolescent-/adult-onset cerebral form/cerebello-brainstem form of adrenoleukodystrophy at early stages. Indications for haematopoietic stem cell transplantation included cerebral form of adrenoleukodystrophy or cerebello-brainstem form of adrenoleukodystrophy with Loes scores up to 13, the presence of progressively enlarging white matter lesions and/or lesions with gadolinium enhancement on brain MRI. Clinical outcomes of haematopoietic stem cell transplantation were evaluated by the survival rate as well as by serial evaluation of clinical rating scale scores and neurological and MRI findings. Clinical courses of eight patients who did not undergo haematopoietic stem cell transplantation were also evaluated for comparison of the survival rate. All the patients who underwent haematopoietic stem cell transplantation survived to date with a median follow-up period of 28.6 months (4.2-125.3 months) without fatality. Neurological findings attributable to cerebral/cerebellar/brainstem lesions became stable or partially improved in all the patients. Gadolinium-enhanced brain lesions disappeared or became obscure within 3.5 months and the white matter lesions of MRI became stable or small. The median Loes scores before haematopoietic stem cell transplantation and at the last follow-up visit were 6.0 and 5.25, respectively. Of the eight patients who did not undergo haematopoietic stem cell transplantation, six patients died 69.1 months (median period; range 16.0-104.1 months) after the onset of the cerebral/cerebellar/brainstem lesions, confirming that the survival probability was significantly higher in patients with haematopoietic stem cell transplantation compared with that in patients without haematopoietic stem cell transplantation (P = 0.0089). The present study showed that haematopoietic stem cell transplantation was conducted safely and arrested the inflammatory demyelination in all the patients with adolescent-/adult-onset cerebral form/cerebello-brainstem form of adrenoleukodystrophy when haematopoietic stem cell transplantation was conducted in the early stages. Further studies are warranted to optimize the procedures of haematopoietic stem cell transplantation for adolescent-/adult-onset cerebral form/cerebello-brainstem form of adrenoleukodystrophy.

Multinodular and vacuolating neuronal tumor (MVNT): A presumably incidental and asymptomatic case in an intractable epilepsy patient.

INTRODUCTION: Multinodular and vacuolating neuronal tumor (MVNT) had been initially described as an epilepsy-related brain tumor, but recent studies demonstrated it could be found incidentally in non-epilepsy patients. CASE REPORT: A 33-year-old woman with intractable post-encephalitis epilepsy presented a cluster of multinodular T2 hyperintensity in the left temporal lobe, which was very similar to the characteristics of MVNT. Long-term video electroencephalogram demonstrated that the habitual seizures were originated from bilateral temporal area and the interictal epileptic discharges were seen multifocally, although the lesions with MVNT appearance were localized in the left temporal lobe. It was presumed that the epilepsy in this patient was due to encephalitis in the past, and the link between the lesions and the epilepsy in this patient seemed weak. CONCLUSION: Although MVNT had been considered as an epilepsy-related brain tumor, we suggest it is not necessarily preferable to perform surgical resection of MVNT even on patients with epilepsy, unless epileptic foci are highly related to MVNT.

Latency shift in compound muscle action potentials during electroneurography in facial palsy.

OBJECTIVE: Electroneurography (ENoG) reliably predicts the prognosis of facial palsy. However, the results of ENoG are dependent on the location, where the wave is detected, as a compound muscle action potential (CMAP) arising from the facial muscles. To minimize errors in prognostic prediction, we analysed the latencies of facial CMAPs. MATERIALS AND METHODS: Fifty-seven patients with unilateral peripheral facial palsy and 24 healthy volunteers were enrolled. Amplitudes, negative peak latencies (NPL), and rise latencies (RL) of CMAPs were measured on the paralysed and healthy sides in patients and in healthy volunteers. The relationships of these latencies with ENoG values and the lowest House-Brackmann (H-B) scores were also analysed. RESULTS: The amplitude of CMAP on the paralysed side was smaller, and NPL and RL were longer, than those on the healthy side in patients and healthy volunteers (p < 0.01). In patients, there was no difference in NPL between the ENoG < 40% group and the ENoG ≥ 40% group. Conversely, there was a significant difference in RL between the ENoG < 40% group and ENoG ≥ 40% group (p = 0.03). No relationships were observed between NPL or RL and the lowest H-B score. CONCLUSIONS: NPL and RL of CMAP on the paralysed side were equivalent or longer than those on the healthy side. During ENoG for facial palsy, CMAP should be measured on the healthy side first, and then detected (and the amplitude measured) on the paralysed side with reference to CMAP latency on the healthy side, to reduce errors in detecting facial CMAPs.

Effect of istradefylline on mood disorders in Parkinson's disease.

Depression is the most common psychiatric complication in patients with Parkinson's disease (PD). Istradefylline, a new anti-parkinsonian agent with completely different mechanism, improves depression-like symptoms in an experimental disease model; however, there is no report of its effects in PD patients. In this study, the effectiveness of istradefylline for treatment of mood disorders in patients with PD was examined in an open-label trial. Thirty PD patients were enrolled. All patients had scores of higher than cut-off level in at least one of the following batteries: Snaith-Hamilton Pleasure Scale Japanese version (SHAPS-J), Apathy scale, or Beck Depression Inventory-2nd edition (BDI). Following study enrollment, all patients received 20 mg of istradefylline, and the dose was increased to 40 mg after 4 weeks. Results from these 3 batteries and the Unified Parkinson's Disease Rating Scale (UPDRS) score were assessed every 2-4 weeks until 12 weeks and the changes in these scores were analyzed. Following administration of istradefylline, the scores of SHAPS-J, Apathy scale, and BDI were significantly improved over time. Significant improvement was also found in the UPDRS score; however, no significant correlation was observed between the score change in these 3 batteries and UPDRS motor function. This is the first study to show the effectiveness of istradefylline for treatment of mood disorders in PD independent of improvement of parkinsonian motor symptoms. In the future, this should be confirmed in a double-blind placebo-controlled trial.

Cetuximab with radiotherapy as an alternative treatment for advanced squamous cell carcinoma of the temporal bone.

The prognosis of advanced temporal bone cancer is poor, because complete surgical resection is difficult to achieve. Chemoradiotherapy is one of the available curative treatment options; however, its systemic effects on the patient restrict the use of this treatment. A 69-year-old female (who needed peritoneal dialysis) presented at our clinic with T4 left external auditory canal cancer and was treated with cetuximab plus radiotherapy (RT). The primary lesion showed complete response. The patient is currently alive with no evidence of disease two years after completion of the treatment and does not show any late toxicity. This is the first advanced temporal bone cancer patient treated with RT plus cetuximab. Cetuximab plus RT might be a treatment alternative for patients with advanced temporal bone cancer.

Cholesterol granuloma presenting with facial nerve paralysis following translabyrinthine surgery: A case report.

BACKGROUND: Cholesterol granuloma (CG) is a foreign body giant cell inflammatory reaction to blood degradation products, and clinically presents as a cyst with a thick fibrous lining filled with brownish-yellow fluid. We report an unusual case of CG with facial nerve paralysis 9 years after translabyrinthine (TL) surgery for vestibular schwannoma (VS) removal. CASE: A 70-year-old woman, who underwent TL surgery previously, presented with left facial palsy (FP). CT findings revealed devastated cochlea and uncovered facial nerve, and progression of FP up to House-Brackmann grade 6 was observed. Therefore, we suspected recurrence of cystic VS or facial schwannoma, although MRI was inconsistent with that of schwannoma. The cyst was completely surgically excised, and histopathology confirmed CG diagnosis. Postoperatively her facial movement improved to grade 4. Recurrence has not been encountered since 7 years. CONCLUSION: During follow-up after TL surgery for VS, care should be taken for possibility of CG occurring.

Safety and efficacy of adenotonsillectomy for obstructive sleep apnea in infants, toddlers and preschool children.

OBJECTIVE: To investigate and compare the safety and efficacy of adenotonsillectomy (AT) on obstructive sleep apnea (OSA) in infants and toddlers (IT) with preschool children (PS), and charts of 147 children between the ages of 11 months and 6 years were reviewed. METHODS: Harmonic Scalpel (HS) was introduced into AT to reduce the operative duration and intraoperative hemorrhage. Preoperative and postoperative apnea-hypopnea indices (AHI) values obtained by the type 3 portable monitoring device, and the change achieved by AT were statistically compared between IT group (N=50) and PS group (N=97). The mean operative duration, the mean amount of intraoperative hemorrhage, the incidence of postoperative hemorrhage, the frequency of abnormal postoperative chest X-ray findings, and the length of hospital stay were also compared between the two groups. All statistical analyses were conducted using either the Student's t test or Fischer's exact test, and p-values <0.05 were considered statistically significant. RESULTS: In the IT group, the mean preoperative AHI value was 13.5±7.1 and decreased to 4.7±3.4 postoperatively. In the PS group, the mean AHI value changed from 16.0±10.2 to 4.4±2.4. There were statistically significant differences between the preoperative and postoperative AHI values in both the IT and PS groups, but there were no statistically significant differences between the IT and PS groups. The mean operative durations in the IT group for tonsillectomy and adenoidectomy were 12.8±6.7 min and 19.5±8.1 min, respectively. The corresponding values in the PS group were 14.5±6.6 min and 22.9±9.7 min, respectively. The mean tonsillectomy durations were comparable, but the adenoidectomy duration was statistically shorter in the IT group. In the IT group, the mean amounts of intraoperative hemorrhage during tonsillectomy and during adenoidectomy were 6.0±5.1 and 18.9±10.6 g, respectively. The corresponding values in the PS group were 6.4±5.4 g and 26.2±13.4 g, respectively. The mean tonsillectomy blood loss was comparable between the groups but was statistically less during adenoidectomy in the IT group. There were no statistical differences between the two groups in the incidence of postoperative hemorrhage and of abnormal findings in the postoperative chest X-ray, and in the length of hospital stay. CONCLUSION: AT in IT can be performed without major perioperative complications and should be considered the primary treatment of OSA from infancy to early childhood. Ultrasonic devices may contribute to increasing the safety of this surgical treatment.

Home monitoring using portable polygraphy for perioperative assessment of pediatric obstructive sleep apnea syndrome.

OBJECTIVE: To overcome very few facilities available for polysomnography, a portable device of polygraphy was introduced into home monitoring for the assessment of obstructive sleep apnea syndrome (OSAS) in children. METHODS: Forty-eight children (aged 2-11) presenting with snoring and sleep apnea were subjected to home monitoring. Sleeptester™ (Fukuda Lifetech, Japan) was used for this purpose, which was equipped with 5 channels for oronasal airflow, thoracoabdominal effort, snoring, body position, and oximetry (SpO2). Sensors were placed by guardians, and they were requested to attend their children as long as possible during a night. Results were analyzed manually by sleep technologists. Adenotonsillectomy was performed in all 48 children, and the same monitoring was utilized postoperatively. RESULTS: The mean duration of monitoring was 460 ± 172 min. (Mean ± S.D.) in the preoperative test and 471 ± 126 min. in the postoperative test. The mean apnea-hypopnea index (AHI) was 20.6 ± 16.6 and 4.4 ± 2.1, respectively. There was a statistically significant decrease (p < 0.001). The lowest SpO2 value was 76.7 ± 17.1% preoperatively and 80.8 ± 14.6% postoperatively, demonstrating no significant difference (p = 0.16) CONCLUSION: Attended home monitoring by guardians using a portable device can be useful in the perioperative assessment of pediatric OSAS.

Initial lesions in Bell's palsy and Ramsay-Hunt syndrome.

CONCLUSION: The antidromic facial nerve response (AFNR) revealed that the initial lesion in both Bell's palsy and Hunt syndrome was mainly located around the geniculate ganglion within 1 week after onset of paralysis. The preoperative AFNR reflected the response near the initial lesion. OBJECTIVES: To review the initial lesion in Bell's palsy and Ramsay-Hunt syndrome using intraoperative monitoring of the AFNR. METHODS: 15 patients, including 8 with Bell's palsy and 7 with Ramsay-Hunt syndrome, were checked for the AFNR before and during transmastoid decompression surgery within 1 week after onset of paralysis. The AFNR monitoring was performed at the posterosuperior part of the anulus tympanicus preoperatively and at 4 points of the facial nerve during surgery. The nerve conduction block sites were diagnosed by the AFNR waveform. RESULTS: The monophasic wave revealing the block site was mainly observed at the geniculate ganglion in both diseases. The latencies of the preoperative responses corresponded to those recorded intraoperatively around the pyramidal segment of the facial nerve.

Magnetic stimulation of the cauda equina in the spinal canal with a flat, large round coil.

Magnetic round coil stimulation over the spinal enlargement activates the spinal nerves at the neuro-foramina level. However, activation of the cauda equina in the spinal canal has never been described in the literature. This study, for which 40 healthy subjects were recruited, activated the cauda equina using a round 20-cm-diameter coil designated as a Magnetic Augmented Translumbosacral Stimulation (MATS) coil. Magnetic stimulation placing the edge of the coil over the L1 and L3 spinous processes elicited compound muscle action potentials (CMAPs) from the abductor hallucis muscle. The CMAPs were compared with those elicited through high-voltage electrical stimulation. The CMAP latencies to L1 level MATS coil stimulation were not significantly different from those evoked by electrical stimulation at the same level. The CMAP latencies to L3 level MATS coil stimulation were varied in each subject. In fact, the L1 level MATS coil stimulation is considered to activate the cauda equina at the root exit site from the conus medullaris; the L3 level MATS coil stimulation activates some mid-part of the cauda equina or the distal cauda equina by spreading current. The MATS coil facilitates evaluation of spinal nerve conduction in the cauda equina.

ER stress is the initial response to polyglutamine toxicity in PC12 cells.

Persistent endoplasmic reticulum (ER) stress and impairment of the ubiquitin-proteasome system (UPS) cause neuronal cell death. However, the relationship between these two phenomena remains controversial. In our current study, we have utilized an expanded polyglutamine fusion protein (polyQ81) expression system in PC12 cells to further examine the involvement of ER stress and UPS impairment in cell death. The expression of polyQ81-induced ER stress and cell death. PolyQ81 also induced the activation of c-Jun N-terminal kinase (JNK) and caspase-3 and an increase in polyubiquitin immunoreactivity, suggesting UPS impairment. ER stress was induced prior to the accumulation of polyubiquitinated proteins. Low doses of lactacystin had almost similar effects on cell viability and on the activation of JNK and caspase-3 between normal cells and polyQ81-expressing cells. These results suggest that ER stress mediates polyglutamine toxicity prior to UPS impairment during the initial stages of these toxic effects.

Lymphomatoid granulomatosis involving central nervous system successfully treated with rituximab alone.

OBJECTIVE: To report the successful treatment of a patient with lymphomatoid granulomatosis (LYG), a rare Epstein-Barr virus-positive lymphoproliferative disorder, using rituximab (anti-CD20 monoclonal antibody). The prognosis for LYG has been reported to be poor, and no satisfactory treatment has been established. Because central nervous system (CNS) involvement of LYG has been known to show poor prognosis, the establishment of an effective treatment for CNS LYG with mild adverse effects is desired. DESIGN: Case report. SETTING: University hospital. PATIENT: A 48-year-old Japanese man presenting with slowly progressive spastic paraparesis diagnosed as LYG involving the CNS and lungs. INTERVENTIONS: The patient was treated with rituximab (375 mg/m2, once weekly for 1 month) alone. Main Outcome Measure Improvement of the lesions on imaging. RESULTS: The neurological signs resolved and the lesions in the CNS and lungs were mostly diminished after the rituximab monotherapy without any adverse effects. The patient stayed in remission for 18 months. CONCLUSION: Rituximab monotherapy was effective in treating the patient; hence, rituximab should be considered as the initial treatment against LYG involving the CNS.

Intraoperative cochlear nerve monitoring in vestibular schwannoma surgery--does it really affect hearing outcome?

OBJECTIVE: The objective of this study was to examine the usefulness of intraoperative cochlear nerve monitoring (ICNM) in the preservation of normal and social hearing in vestibular schwannoma (VS) removal. METHODS: A retrospective chart review was conducted. Of 1315 patients operated for VS between June 1988 and December 2005, 150 patients were subjected to hearing preservation surgery. Among these, 99 patients with preoperative normal and social hearing (class A and B in the modified Sanna classification) and with a small tumor <1.5 cm in size were included in the analysis. The difference in hearing preservation rates between patients operated with and without ICNM was statistically examined using Fisher's exact test. An initial analysis was conducted for the total group. Patients were then divided into two subgroups according to the surgical approach (middle cranial fossa and retrosigmoid-retrolabyrinthine). The effectiveness of ICNM in each subgroup was analyzed. RESULTS: The hearing preservation rate was 26.7% in cases operated with ICNM and 20.8% in cases without ICNM. The difference did not reach statistical significance (p = 0.79). In subgroup analyses, the ICNM did not prove to contribute to the significantly higher hearing preservation rate. CONCLUSIONS: ICNM did not increase the ratio of patients with postoperative normal and social hearing in VS surgery.

The endoscopically measured effects of airway maneuvers and the lateral position on airway patency in anesthetized children with adenotonsillar hypertrophy.

Obstruction of the upper airway is a major challenge for anesthesiologists administering general anesthesia in spontaneously breathing children with adenotonsillar hypertrophy. Lateral positioning is a simple treatment for obstructive sleep apnea. In this study, we examined the effects of body position shifting and common airway maneuvers such as chin lift and jaw thrust on airway patency (stridor score and upper airway dimensions by endoscopy) in anesthetized children scheduled for adenotonsillectomy. Eighteen children aged 1-11 yr were anesthetized with sevoflurane. During spontaneous breathing with 5% sevoflurane and 100% oxygen, upper airway dimensions and stridor score were recorded. After baseline recording, chin lift and jaw thrust were performed in both the supine and the lateral decubitus position. Chin lift, jaw thrust, and lateral position increased the airway dimensions and improved the stridor score. Moreover, lateral positioning enhanced the effects of these airway maneuvers on airway patency. We concluded that lateral positioning combined with airway maneuvers provided better airway patency for anesthetized children with adenotonsillar hypertrophy.

Correlation between the physicochemical property of some nonsteroidal anti-inflammatory drugs and changes in adenosine triphosphate, glutathione and hemoglobin in rat erythrocytes.

This study was conducted to explore the relationship between physicochemical property and toxic effectiveness using rat red blood cells (RBCs). The toxic effectiveness of acid nonsteroidal anti-inflammatory drugs (NSAIDs) was systemically examined by the depletion of intracorpuscular adenosine triphosphate (ATP), glutathione (GSH), and hemoglobin (Hb) at various doses, increased every 5 fmol/RBC. When the RBCs were incubated with NSAIDs, the drugs attained maximum levels within RBC, and the levels were then reduced. The ATP depletion seemed to be observed on the excretion of the drugs prior to the depletions of GSH and Hb. The physicochemical properties of NSAIDs were obtained from QMPRPlus, SMILES code, and CS ChemRaw Ultra. Correlation between their physicochemical properties and their doses for the depletions of ATP, GSH and Hb was performed in comparison with those of the membrane bound enzyme (MBE) inhibiting- and methemoglobin (MHb)-generating drugs. The ATP depletion by NSAIDs was correlated with the GSH depletion and intracorpuscular levels of the drugs, but not with the Hb depletion. The GSH depletion was correlated with the Hb depletion and participated in the lipophilicity of the drugs.