Study on measuring device arrangement of array-type CdTe detector for BNCT-SPECT.

AIM: To design the measuring device arrangement of array-type CdTe detector for BNCT-SPECT. BACKGROUND: In a boron neutron capture therapy, a very serious unsolved problem exists, namely that the treatment effect for BNCT cannot be known during irradiation in real time. Therefore, we have been developing a so-called BNCT-SPECT with a CdTe detector, which can obtain a three-dimensional image for the BNCT treatment effect by measuring 478 keV gamma-rays emitted from the excited state of (7)Li nucleus created by the (10)B(n,α) reaction. However, no practical uses were realized at present, because BNCT-SPECT requires very severe conditions for spatial resolution, measuring time, statistical accuracy and energy resolution. MATERIALS AND METHODS: The design study was performed with numerical simulations carried out by a 3-dimenaional transport code, MCNP5 considering the detector assembly, irradiation room and even arrangement of arrayed CdTe crystals. RESULTS: The estimated count rate of 478 keV gamma-rays was sufficiently large being more than the target value of over 1000 counts/h. However, the S/N ratio did not meet the target of S/N > 1. We confirmed that deterioration of the S/N ratio was caused by the influence of Compton scattering especially due to capture gamma-rays of hydrogen. Theoretical calculations were thereafter carried out to find out whether anti-Compton measurement in an array-type CdTe detector could decrease the noise due to Compton scatterings. CONCLUSIONS: The calculation result showed that the anti-coincidence would possibly increase the S/N ratio. In the next phase, an arrayed detector with two CdTe crystals will be produced to test removal possibility of the anti-coincident event.

Effect of seven tricyclic diterpenoids from needles of Taxus media var. Hicksii on stimulus-induced superoxide generation, tyrosyl or serine/threonine phosphorylation and translocation of cytosolic compounds to the cell membrane in human neutrophils.

Taxol has been widely used as an anticancer drug for ovarian, breast, lung and prostate cancer. Some kinds of Taxus plants are widely distributed in the Northeast Asia region. We have isolated seven tricyclic diterpenoids, taxinine, taxagifine, 5-O-cinnamoyltaxacin I triacetate, 5-decinnamoyltaxinine J, 5-cinnamoyl-9-acetyltaxicin I, taxacin and taxol from the needles of Taxus media var. Hicksii, and investigated their effects on stimulus-induced superoxide generation and translocation of cytosolic compounds to the cell membrane in human neutrophils. Six tricyclic diterpenoids used in this experiment suppressed the superoxide generation induced by N-formyl-methionyl-leucyl-phenylalanine (fMLP) and arachidonic acid (AA) in a concentration-dependent manner. Taxinine significantly suppressed the superoxide generation induced by phorbol 12-myristate 13-acetate (PMA). The compounds also suppressed fMLP- and AA-induced tyrosyl or PMA-induced serine/threonine phosphorylation, and translocation of cytosolic compounds, p47 (phox), p67 (phox) and Rac to the cell membrane in parallel with the suppression of the stimulus-induced superoxide generation.

[Management of anesthesia with artificial pancreas STG-22 for pheochromocytoma resection].

A 74-year-old woman underwent radical nephrectomy for an adrenaline predominant pheochromocytoma in the left adrenal gland. She was pretreated with doxazosin for 3 weeks before surgery. Anesthesia was induced with intravenous fentanyl, midazolam and vecuronium, and inhaled sevoflurane in oxygen. A central venous catheter was inserted into the right internal jugular vein and a PiCCO catheter was inserted into the femoral artery for the monitoring of cardiac function and hemodynamics. In addition, continuous monitoring and automatic control of blood glucose were started using STG-22. Target concentration of blood glucose was set at 120-140 mg x dl(-1). Anesthesia was maintained with sevoflurane and remifentanil. Prostaglandin E1, nitroglycerin and dexmedetomidine were infused continuously from the start of surgery, and the systolic blood pressure was kept within 120-160 mmHg. During surgical manipulation around the tumor, there were sudden increases in blood pressure, heart rate and blood glucose concentration. Thus, phentolamine and landiolol were also administered to control blood pressure and heart rate. On the contrary, after the tumor removal, noradrenaline, dobutamine and milrinone were required to maintain blood pressure. The STG-22 worked well to maintain blood glucose concentrations during surgery without any hyper- and hypoglycemic events.

The accuracy of a continuous blood glucose monitor during surgery.

BACKGROUND: Protocols for tight control of blood glucose can be difficult to achieve in the surgical setting, especially when relying upon intermittent blood glucose testing. A continuous blood glucose monitoring system can facilitate blood glucose management. In the present study, we compared blood glucose measured continuously (STG-22, Nikkiso, Tokyo, Japan), during surgery with coincident measurements obtained intermittently using a conventional laboratory glucometer (ABL 800FLEX (Radiometer Medical Aps, [symbol: see text], Denmark). The goal of the study was to determine the reliability and accuracy of the continuous method during surgery. MATERIAL AND METHODS: Twenty-nine patients scheduled for routine surgery with general anesthesia were enrolled in this study. After anesthetic induction, a 20G IV catheter was inserted in a peripheral forearm vein and connected to the continuous blood glucose monitor. A radial arterial catheter was also inserted from which samples for blood glucose estimation were obtained by an anesthesiologist, following an established protocol of discarding 3 mL of blood before the actual blood sampling. Blood glucose was measured by ABL 800FLEX immediately after sampling. One hundred points of paired blood glucose values were obtained, which were compared using Bland and Altman analysis. RESULTS: Bias and upper and lower limits of agreement were -2.6, 23, and -28, respectively. The percentage error of the lower/upper limits of agreement was 21% and 18%, respectively. DISCUSSION AND CONCLUSIONS: The blood glucose measurements obtained continuously agreed with the coincident intermittent measurements within 21%. The STG-22 may still be useful for following changes continuously and reducing the frequency of intermittent measurement, but the need for testing samples with a reliable device is not eliminated.

Inhibitory effects of ginsenosides from the root of Panax ginseng on stimulus-induced superoxide generation, tyrosyl or serine/threonine phosphorylation, and translocation of cytosolic compounds to plasma membrane in human neutrophils.

The effects of five ginsenosides (G-Rh2, -Rd, -Rb1, -Rb2, -Rh1) isolated from the root of Panax gingseng on stimulus-induced superoxide generation in human neutrophils were evaluated by measuring the reduction of ferricytochrome c. The tyrosyl or serine/threonine phosphorylation of neutrophil proteins and translocation of p47phox, p67phox, and Rac to the plasma membrane were detected using specific monoclonal antibodies. G-Rh2 significantly suppressed superoxide generation induced by N-formylmethionyl-leucylphenylalanine (fMLP), phorbol 12-myristate 13-acetate (PMA), and arachidonic acid (AA) in a concentration-dependent manner. G-Rh1 showed a comparably lower suppression on fMLP-induced superoxide generation. G-Rd, -Rb1, and -Rb2 also suppressed AA-induced superoxide generation in high concentrations. G-Rd and G-Rb1 showed no effect on fMLP- and PMA-induced superoxide generation. FMLP-, PMA-, and AA-induced tyrosyl or serine/threonine phosphorylation and translocation of p47phox, p67phox, and Rac to the plasma membrane were in parallel with the suppression of the stimulus-induced superoxide generation.

The effects of vasodilation on cardiac output measured by PiCCO.

OBJECTIVES: The purpose of this study was to investigate the effects of vasodilation on cardiac output (CO) measured by pulse contour method using PiCCO (Pulsion Medical Systems AG, Munich, Germany) in comparison with CO by the thermodilution method. DESIGN: A prospective observational study. SETTINGS: An operating room in a university hospital. PARTICIPANTS: Twenty patients scheduled for off-pump coronary artery bypass grafting. INTERVENTIONS: After anesthesia induction with midazolam, fentanyl, and vecuronium, the PiCCO catheter and pulmonary artery catheter were inserted. Before the initiation of surgery, progressively higher infusions of prostaglandin E1 (PGE1) were administered for vasodilation. MEASUREMENTS AND MAIN RESULTS: CO was measured before PGE1 (control); at PGE1 0.01, 0.02, and 0.04 microg/kg/min; and 15 minutes after stopping PGE1 infusion. Systemic vascular resistances (SVRs) at PGE1 0.02 and 0.04 microg/kg/min were significantly lower than the control value. The correlation coefficient (R(2)) at each point, percentage error, and limits of agreement (bias +/- 2 standard deviation of bias) were 0.89, 17, -0.21 +/- 0.53 before PGE1; 0.72, 27, -0.31 +/- 0.93 at 0.01 microg/kg/min; 0.53, 40, -0.62 +/- 1.41 at 0.02 microg/kg/min; 0.57, 34, -0.61 +/- 1.26 at 0.04 microg/kg/min; and 0.97, 21, -0.14 +/- 0.69 L/min 15 minutes after the end of infusion, respectively. CONCLUSIONS: PiCCO may not be an alternative to thermodilution measurement without recalibration when SVR decreases by infusion of PGE1 > or = 0.02 microg/kg/min.

[Pulmonary aspiration during anesthetic induction in a patient with a history of distal gastrectomy].

We experienced a case of pulmonary aspiration during anesthetic induction. Posterior laminoplasty was scheduled for a 59-year-old man with ossification of posterior longitudinal ligament, who had undergone distal gastrectomy 30 years ago. Anesthesia was induced with intravenous administration of midazolam and fentanyl, and inhalation of sevoflurane was gradually increased to 7% in oxygen under spontaneous breathing, since difficult intubation had been predicted due to poor neck mobility However, the patient vomited during laryngoscopy. Orotracheal intubation was performed with a fiberscope and the excreta was suctioned through the endotracheal tube. The patient was admitted to the ICU after taking chest X-ray and the operation was postponed for one month. At the second attempt, awake intubation was planned for the patient under sedation with dexmedetomidine. Food intake and drinking were restricted for the patient from the previous night. After administration of fentanyl, continuous administration of intravenous dexmedetomidine was started, and 2% lidocaine viscous solution was gargled. Endotracheal intubation was successfully performed using AirWay Scope without pulmonary aspiration, and midazolam was administered intravenously. Surgery was completed without any troubles, and the patient was extubated fully awake.

Different effects of sulfur amino acids on prolidase and prolinase activity in normal and prolidase-deficient human erythrocytes.

BACKGROUND: Prolidase and prolinase activity is known to be enhanced significantly in some diseases. Recently, the effect of amino acids on prolidase and prolinase activity in normal and prolidase-deficient human erythrocytes was investigated. It was reported that both enzymes were enhanced by glycine and alanine in the presence of MnCl(2). METHODS: Erythrocytes were isolated from heparinized blood from normal human and a patient with prolidase deficiency. Effects of various sulfur amino acids on prolidase and prolinase activities against iminodipeptides in the presence of 1 or 0.1 mmol/l MnCl(2) were investigated. RESULTS: Prolinase activity against prolylglycine in normal and prolidase-deficient erythrocyte lysates was inhibited by L-methionine, NAc-L-methionine and D,L-methionine in a concentration-dependent manner, but D-methionine enhanced the activity in low concentrations (0-20 mmol/l). D,L-Homocysteine inhibited the activity more strongly than other sulfur amino acids tested in a concentration-dependent manner. On the other hand, prolidase activity against glycylproline was enhanced by L-methionine, D-methionine, D,L-methionine, D,L-homocysteine thiolactone and D,L-ethionine. The rates of enhancement by these sulfur amino acids were in the following order: D,L-ethionine>D,L-methionine, D-methionine, D,L-homocysteine thiolactone>L-methionine (10 mmol/l). CONCLUSION: The prolinase activity in normal and prolidase-deficient erythrocyte lysates was inhibited by L-methionine, D,L-ethionine and D,L-homocysteine. On the other hand, prolidase activity in their erythrocyte lysates was enhanced by D,L-ethionine, D-methionine and L-methionine. These results indicate the effects of these sulfur amino acids on prolidase and prolinase activities were different.

[A case of subarachnoid hemorrhage with different BIS values observed between the right and left forehead].

We experienced a case of subarachnoid hemorrhage with different BIS values observed between the right and left forehead. A 71-year-old woman was scheduled for endovascular coiling. She had been already intubated and showed little response to painful stimulation without sedation (Japan coma scale; III-200). Anesthesia was induced and maintained with propofol. BIS monitoring was started from the right forehead before anesthetic induction (r-BIS), and additional monitoring from the left side was started after induction (1-BIS). When the operation was started, 1-BIS was 40 and r-BIS was 30. During the operation, 1-BIS was always higher than r-BIS; 1-BIS was 49 +/- 10 and r-BIS was 37 +/- 7 (mean +/- SD). The difference between r-BIS and 1-BIS was more than 10 for 68% of operation time. Since abnormal EEG pattern was observed, we concluded that abnormal EEG influenced BIS value, and 1-BIS after anesthesia was higher than that of her actual conscious level. EEG of a patient with acute stroke sometimes shows an abnormal pattern. Anesthesiologists should keep in mind the possibility that an abnormal EEG might influence BIS value.

Performance testing of the neutron flux monitors from 10keV to 1MeV developed for BNCT: A preliminary study.

The neutron flux monitors from 10keV to 1MeV designed for boron neutron capture therapy (BNCT) were experimentally tested with prototype monitors in an appropriate neutron field produced at the intense deuterium-tritium neutron source facility OKTAVIAN of Osaka University, Japan. The experimental test results and related analysis indicated that the performance of the monitors was good and the neutron fluxes from 10keV to 1MeV of practical BNCT neutron sources can be measured within 10% by the monitors.

Effect of Agkistroden blomhoffi (mamushi) on superoxide generation in human neutrophils.

BACKGROUND: The purpose of this study is to investigate the effect of Agkistroden blomhoffi (mamushi) aqueous extract on stimulus-induced superoxide generation in human neutrophils. METHODS: Superoxide generation was assayed by measuring the reduction of ferricytochrome C (cyt c) using a dual-beam spectrophotometer. The phosphorylation of neutrophil proteins and the translocation of cytosolic compounds to the cell membrane were detected using specific monoclonal antibodies. RESULTS: Mamushi aqueous extract markedly suppressed fMLP-induced superoxide generation in a concentration-dependent manner. fMLP-induced translocation of cytosolic compounds p47phox, p67phox and Rac to the cell membrane was suppressed in parallel to the suppression of superoxide generation. The fractions with MW below 10 kDa dose-dependently suppressed tyrosyl phosphorylation of 45.0, 77.6 and 99.5 kDa proteins in fMLP-treated human neutrophils; the inhibition of tyrosyl phosphorylation was in parallel to that of the fMLP-induced translocation of p47phox to the cell membrane and superoxide generation. CONCLUSIONS: Mamushi aqueous extract markedly suppressed fMLP-induced superoxide generation in human neutrophils and also suppressed the translocation of cytosolic compounds to the cell membrane and tyrosyl phosphorylation of proteins. The efficacious components are the fractions with MW below 10 kDa. O-phosphoserylethanolamine, a new dipeptide isolated from mamushi, also suppressed fMLP-induced superoxide generation in human neutrophils in a dose-dependent manner.

The influence of hyperbaric bupivacaine temperature on the spread of spinal anesthesia.

The distribution of spinal anesthesia is affected by the density and viscosity of the local anesthetic solution that, in turn, may be influenced by the temperature of the injectate. Our hypothesis in the present study was that the temperature of the injectate influences its distribution into the subarachnoid space. We measured the density and viscosity of hyperbaric 0.5% bupivacaine at 25 degrees C and 37 degrees C and tested the onset and extent of spinal anesthesia achieved by these solutions in 36 patients. The densities of the two solutions were similar (mean [sd]): 25 degrees C, 1.028 [0.000], versus 37 degrees C, 1.028 [0.000] (g/mL), but the viscosity was more at 25 degrees C than at 37 degrees C (0.01116 [0.00003] versus 0.00843 [0.00002] g x cm(-1) x s(-1); P < 0.001). The maximum cephalad extent of loss of pinprick sensation was significantly higher with 37 degrees C (T2 with 37 degrees C versus T5 with 25 degrees C; P < 0.001), but the time to achieve peak block height was similar. In conclusion, we showed a consistent, but modest, increase in the cephalad level of spinal anesthesia by warming hyperbaric bupivacaine 0.5% from 25 degrees C to 37 degrees C. Viscosity was reduced in the warmed solution, but it is unclear if this or other factors led to the difference in spinal anesthetic level.

[A case of sudden occurrence of complete left bundle branch block during emergency surgery].

We experienced a case of sudden occurrence of complete left bundle branch block during emergency surgery. A 59-year-old man suffered from facial bone fracture and eye ball injury. Repair of facial bone and removal of eye ball surgery were scheduled. Chest X-ray, echocardiography, blood counts and laboratory data were within normal limits. Awake intubation was performed. Anesthesia was maintained with 2-3% sevoflurane in 1 l x min(-1) of oxygen and 2 l x min(-1) of nitrous oxide. After induction of anesthesia, tracheostomy was performed with combined use of local anesthesia with 6 ml of 1% lidocaine with 1/200000 epinephrine. Then removal of eye ball surgery was started and finished uneventfully. During repair of facial bone fracture, we found an unexpected complete left bundle branch block. After rapid infusion of 1000 ml acetic Ringer's solution, the complete left bundle branch block disappeared. After surgery, mannitol administration at the previous hospital was noticed. Complete left bundle branch block in this case might have been induced by hypovolemia and hyperpotassemia due to osmotic diuresis by mannitol.

Basic detection property of an array-type CdTe detector for BNCT-SPECT - Measurement and analysis of anti-coincidence events.

Our research group is now investigating a BNCT-SPECT system with cadmium tellurite (CdTe) detectors, which can obtain a three-dimensional image of the BNCT treatment effect by measuring the 478keV gamma-rays emitted from an excited state of the 7Li nucleus generated by the 10B(n,α) reaction. The BNCT-SPECT system is composed of a collimator and an array-type CdTe detector. In this study, we produced an array detector with two CdTe elements to test the basic detection property for anti-coincidence events. Our investigation confirmed that the detector offers an improved S/N ratio by the anti-coincidence detection. We also proposed an estimation method using the MCNP5 to analyze coincidence events in the detector.

Experimental study on the performance of an epithermal neutron flux monitor for BNCT.

The performance of an epithermal neutron (0.5eV

Characterization of prolidase activity in erythrocytes from a patient with prolidase deficiency: comparison with prolidase I and II purified from normal human erythrocytes.

OBJECTIVES: The purpose of this study was to investigate the effect of various amino acids and their metabolites on the activities of prolidase I and II from human erythrocytes compared to those in a patient with prolidase deficiency. DESIGN AND METHODS: Prolidase I and II from human erythrocytes were purified by using column chromatography. Prolidase activity against various iminodipeptides was determined by spectrophotometry using Chinard's method. RESULTS: The activities of prolidase I and II against glycylproline and methionylproline were enhanced by glycine, L- and D-isoforms of alanine and serine and D-isoforms of valine, leucine and isoleucine. L-isoforms of branched amino acids inhibited the activity of prolidase I. On the other hand, the activity of prolidase II was enhanced by all of these L-branched amino acids. The patient's prolidase activity was also enhanced by all the L- and D-branched amino acids. CONCLUSION: The activities of prolidase I and II against various iminodipeptides were prominently enhanced by glycine, but the effect of L-valine differed between the two enzymes. Enzymatic properties of the patient's prolidase were essentially the same as those of prolidase II.

Effect of sulfur amino acids on stimulus-induced superoxide generation and translocation of p47phox and p67phox to cell membrane in human neutrophils and the scavenging of free radical.

BACKGROUND: Various cystathionine metabolites are in the urine of the patients with cystathioninuria. Among these metabolites, cystathionine ketimine significantly enhanced N-formyl-methionyl-leucyl-phenylalanine (fMLP)-induced superoxide generation in parallel with tyrosyl phosphorylation of 45 kDa protein in human neutrophils. METHODS: We investigated the effect of various sulfur amino acids on fMLP-, phorbol-12-myristate-13-acetate (PMA)- and arachidonic acid (AA)-induced superoxide generation in human neutrophils. In addition, the effects of these sulfur amino acids on the membrane translocation of cytosolic compounds p47(phox) and p67(phox) and on the scavenging of superoxide anions were investigated. RESULTS: When the cells were preincubated with various sulfur amino acids, fMLP-induced superoxide generation was enhanced by D,L-homocysteine and D,L-homocysteine-thiolactone but was inhibited by other sulfur amino acids in a concentration-dependent manner. The AA-induced superoxide was enhanced by L-cysteine, N-acetyl-L-cysteine and D,L-homocysteine. The strength of enhancing effect was: L-cysteine>>N-acetyl-L-cysteine>D,L-homocysteine. On the other hand, the superoxide generation was weakly inhibited by L-cystathionine. The superoxide generation induced by PMA was weakly inhibited by L-cysteine, N-acetyl-L-cysteine and L-cystathionine. Homocysteine and D,L-homocysteine-thiolactone had no effect. In addition, D,L-homocysteine also enhanced translocation to the cell membrane of cytosolic compounds p47(phox) and p67(phox). Conversely, L-cystathionine and N-acetyl-L-cysteine inhibited the translocation to membrane of p47(phox) and p67(phox) in a concentration-dependent manner. N-acetyl-L-cysteine and L-cysteine revealed scavenging activity against 2,2-diphenyl-1-picrylhydrazyl (DPPH) radicals. The sulfur amino acids tested also indicated radical scavenging activity on superoxide anion generated by phenazine methoxysulfate (PMS)-NADH system. CONCLUSION: D,L-homocysteine and D,L-homocysteine-thiolactone enhanced fMLP-induced superoxide generation by the increment of translocation to membrane of p47(phox) and p67(phox). L-cystathionine and N-acetyl-L-cysteine suppressed fMLP- and PMA-induced superoxide generation by the inhibition of translocation to membrane of p47(phox) and p67(phox). N-acetyl-L-cysteine also had scavenging activity against DPPH radicals and superoxide anion.

A comparison of the rate of bacterial contamination for prefilled disposable and reusable oxygen humidifiers.

BACKGROUND: Prefilled disposable oxygen humidifiers are considered to prevent nosocomial pneumonia in hospital wards. However, their usefulness in intensive care units (ICUs) has not yet been established. In this study, we evaluated and compared contamination in prefilled disposable oxygen humidifiers and that in reusable oxygen humidifiers. METHODS: Six oxygen outlets in the ICU were used. Prefilled disposable oxygen humidifiers and reusable oxygen humidifiers were attached to each wall-mounted oxygen outlet using a 2-way connector. Nonsterile nasal cannulae and tubes were connected to the humidifiers through which 5 L/min of oxygen was delivered continuously. Water samples (5 mL) from each humidifier were collected on the first day and every 7 days thereafter for a period of 56 days. Each water sample was incubated aerobically at 35 degrees C for 48 hours and observed daily for bacterial growth. RESULTS: Bacterial growth was observed only once in one sample from each humidifier type. Gram-positive cocci, 40 colony-forming units in the disposable oxygen humidifier and 10 colony-forming units in the reusable oxygen humidifier, were detected. Dust was observed from the 35th day onward only in the reusable oxygen humidifier. CONCLUSION: In the ICU, bacterial contamination does not occur in oxygen humidifiers even after 56 days of continuous use. However, dust does accumulate in the reusable oxygen humidifier after 35 days of continuous use.

Blood flow velocity of the femoral vein with foot exercise compared to pneumatic foot compression.

STUDY OBJECTIVE: To compare the effects of foot exercise with an intermittent pneumatic foot compression (IPC) device on blood flow velocity of the femoral veins. DESIGN: Prospective, controlled study. SETTING: General intensive care unit of a university hospital. PATIENTS: 20 patients on bed rest in the intensive care unit. INTERVENTIONS: Patients were divided into 2 groups: group A, foot exercise (n = 10); and group B, IPC device (n = 10). The foot exercise was done once by a nurse for 5 minutes with the dorsiflexion of the ankle (15 times per minute) in group A patients. The IPC device (A-V Impulse System, compression setting: 130 mm Hg for 3 seconds followed by a resting period of 60 seconds) was used for 2 hours in group B. MEASUREMENTS: Peak blood flow velocity of the femoral vein was measured using the ultrasound unit with a 7.5-MHz linear array probe (ALOKA SSD-5500) at 0, 5, 15, 30, 60, and 120 minutes. MAIN RESULTS: Peak blood flow velocities in both groups increased significantly vs the control values during the study. At 5 minutes, group A showed a significant increase in the peak blood flow velocity compared with group B. CONCLUSIONS: Foot exercise by a nurse for 5 minutes was equally or more effective compared with the IPC device in increasing peak blood flow velocity of the femoral vein. The effect of the 5-minute foot exercise lasted for 2 hours.

[A case of thoraco-amniotic shunt for congenital cystic adenomatoid malformation].

Congenital cystic adenomatoid malformation (CCAM) is a congenital pulmonary anomaly, which may lead to fetal hydrops, pulmonary hypoplasia, and fetal or neonatal death. Recently, diagnosis and surgery for fetus have been improved. We experienced a case of CCAM, classified in Stocker class I, with a single cyst of about 5 cm in diameter. A 32 year-old pregnant woman had a fetus diagnosed as CCAM at 25 th gestational week. The thoraco-amniotic shunt placement using a modified double pig tail catheter was performed at 27 th gestational week under general anesthesia with 1% isoflurane in oxygen 2 l x min(-1) and nitrous oxide 4 l x min(-1), and 100 microg of fentanyl. Fetal movement was suppressed during surgery. This fetal therapy was effective and the cyst disappeared after surgery. The baby was delivered with caesarian section under spinal anesthesia with 0.5% bupivacaine 2.5 ml. On the next day, right lung lobectomy was accomplished under general anesthesia with fentanyl 0.2 mg and pancuronium 6.0 mg. Anesthesia with isoflurane, nitrous oxide, and fentanyl was useful for the fetal surgery of thoraco-amniotic shunt placement. Consequently, caesarian section and lung lobectomy were completed successfully.