Anesthetic management of pheochromocytoma and paraganglioma for patients with Fontan circulation: a case series.

BACKGROUND: Anesthetic management of pheochromocytoma and paraganglioma with Fontan circulation is challenging for physicians, with attention to cardiovascular physiology. CASE PRESENTATION: We performed anesthetic management for pheochromocytoma and paraganglioma in three patients with Fontan circulation. We maintained intraoperative central venous pressure at preoperative level under fluid infusion and administrating nitric oxide to decrease pulmonary arterial resistance. We administered noradrenaline or vasopressin if low blood pressure was present despite adequate central venous pressure. Although noradrenaline is prevalent for the case of noradrenaline-secreting tumor especially after resection, we could maintain blood pressure to administrate vasopressin without increasing central venous pressure. Retroperitoneal laparoscopic approach which could avoid intra-abdominal adhesions might be selectable as case 3. CONCLUSIONS: Sophisticated management is required for pheochromocytoma and paraganglioma with Fontan circulation.

A new combination technique of the modified Robicsek wire fixation and plate fixation achieves effective repair of transverse sternal fracture: a report of two cases.

BACKGROUND: To maximize the therapeutic effect for complicated sternal fracture, we should know advantages and disadvantages of each surgical repositioning technique, and the choice of an appropriate procedure is essential. We report two successful cases for which a combination of two existing techniques, modified Robicsek wire fixation and locked titanium plate fixation, was applied to transverse sternal fracture with flail chest. CASE PRESENTATION: One patient experienced a transverse sternal and rib fracture due to a traffic injury. Flail chest due to a highly displaced transverse sternal fracture made withdrawal of the ventilator impossible. Another patient, who developed fulminant myocarditis, experienced a transverse sternal fracture resulting from chest compression during cardiopulmonary resuscitation. Severe paradoxical respiratory movement was a limiting factor for cardiac and respiratory rehabilitation. In both cases, a transverse sternal fracture was difficult to correct non-invasively and indicated surgical repair. The surgical repositioning and fixation greatly contributed to the improvement of the respiratory movement, and the patients were successfully withdrawn ventilator support. CONCLUSION: The combination of modified Robicsek wire fixation and locked titanium plate fixation for a complicated sternal fracture employs the complementary and comparative advantages of each procedure and effective fixation may be achieved.

Long working hours and skipping breakfast concomitant with late evening meals are associated with suboptimal glycemic control among young male Japanese patients with type 2 diabetes.

AIMS/INTRODUCTION: To assess the associations of working conditions, eating habits and glycemic control among young Japanese workers with type 2 diabetes. MATERIALS AND METHODS: This hospital- and clinic-based prospective study included 352 male and 126 female working patients with diabetes aged 20-40 years. Data were obtained from June to July 2012 and June to July 2013. Logistic regression analysis was used to estimate multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for suboptimal glycemic control (glycosylated hemoglobin level of ≥7%) obtained from June to July 2013. RESULTS: Multivariable logistic regression analysis showed that disease duration of ≥10 years (OR 2.43, 95% CI 1.02-5.80), glycosylated hemoglobin level of ≥7% in 2012 (OR 8.50, 95% CI 4.90-14.80), skipping breakfast and late evening meals (OR 2.50, 95% CI 1.25-5.00) and working ≥60 h/week (OR 2.92, 95% CI 1.16-7.40) were predictive of suboptimal glycemic control in male workers, whereas a glycosylated hemoglobin level of ≥7% in 2012 (OR 17.96, 95% CI 5.93-54.4), oral hyperglycemic agent therapy (OR 12.49, 95% CI 2.75-56.86) and insulin therapy (OR 11.60, 95% CI 2.35-57.63) were predictive of suboptimal glycemic control in female workers. CONCLUSIONS: Working ≥60 h/week and habitual skipping breakfast concomitant with late evening meals might affect the ability of young male workers with type 2 diabetes to achieve and maintain glycemic control.

Socioeconomic status and type 2 diabetes complications among young adult patients in Japan.

OBJECTIVE: To assess the relationship between socioeconomic status (SES) and complications of type 2 diabetes among young adults in Japan. DESIGN: A cross-sectional study. SETTING: Outpatient wards of 96 member hospitals and clinics of the Japan Federation of Democratic Medical Institutions. PARTICIPANTS: A total of 782 outpatients with type 2 diabetes (525 males, 257 females), aged 20-40 years as of March 31, 2012. After excluding 110 participants whose retinopathy diagnosis was in question, 672 participants were analyzed. MEASUREMENTS: We examined the relations between SES (educational level, income, type of public healthcare insurance, and employment status) and diabetes complications (retinopathy and nephropathy) using a multivariate logistic regression analysis. RESULTS: The prevalence of type 2 diabetic retinopathy was 23.2%, while that of nephropathy was 8.9%. The odds of having retinopathy were higher among junior high school graduates (OR 1.91, 95% CI 1.09-3.34), patients receiving public assistance (OR 2.19, 95% CI 1.20-3.95), and patients with irregular (OR 1.72, 95% CI 1.03-2.86) or no employment (OR 2.23, 95% CI 1.36-3.68), compared to those with a higher SES, even after covariate adjustment (e.g., age, gender, body mass index). Similarly, the odds of having nephropathy were higher among patients with middle (OR 3.61, 95% CI 1.69-8.27) or low income levels (OR 2.53, 95% CI 1.11-6.07), even after covariate adjustment. CONCLUSIONS: Low SES was associated with a greater likelihood of type 2 diabetes complications in young adults. These findings suggest the necessity of health policies that mitigate socioeconomic disparity and thereby reduce the prevalence of diabetic complications.