[Postoperative numerical rating scale in patients undergoing gynecological laparotomy under general anesthesia combined with either single epidural injection or transverses abdominis plane block].

BACKGROUND: After the operation, early postoperative ambulation has been recommended for thromboprophylaxis. As more anticoagulant drugs have become available, hemorrhagic complication of epidural anesthesia is the focus of attention. Recently, the spread of ultrasound-guided nerve block has improved the efficacy of the transversus abdominis plane block Therefore, we compared transversus abdominis plane block with epidural anesthesia regarding postoperative numerical scale in patients undergoing gynecological surgery. METHODS: Doses of administrated narcotics during anesthesia, frequencies of administration of analgesics and vomiting up to 24 hours postoperatively, and numerical rating scale (NRS) at the first and 18th postoperative hours were retrospectively surveyed in patients undergoing gynecological laparotomy. Anesthesia was maintained with sevoflurane combined with either single epidural injection of 6-12 ml of 0.375- 0.75% lopivacaine with 2-4 mg of morphine in 16 patients (Epi group) or ultrasound-guided transverses bilateral abdominis plane block (TAPB) using 20 ml of 0.375% lopivacaine, respectively, in 16 patients (TAP group). RESULTS: No significant differences were found in age, height, weight, ASA-physical status, volume of intraoperative blood loss and surgical time. Both the total administrated doses of remifentanil and fentanyl during anesthesia in TAP group were significantly larger than those in Epi group. Number of postoperative vomiting was larger in Epi group. However, NRS at the postoperative first and 18th hours showed no significant differences between the two groups. The technique of ultrasound-guided TAPB is relatively easy compared with that of epidural injection and TAPB has an advantage in availability in patients receiving anticoagulant therapy. CONCLUSIONS: No significant difference in postoperative NRS between two groups in this survey suggests that TAPB in combination with appropriate postoperative pain service is useful in patients contraindicated to epidural puncture.

[The use of rocuronium in a patient with Becker muscular dystrophy].

We report a case of thoracoscopic pulmonary resection for pneumothorax in a patient with Becker muscular dystrophy The sensitivity of nondepolarizing muscle relaxant in a patient with muscle dystrophy is reportedly higher than in a patient without muscle disease, and the duration of the effect is known to be prolonged. In a 26-year-old man (height 160 cm, weight 39 kg) with Becker muscular dystrophy, general anesthesia was induced with target controlled infusion of propofol (3.0 microg x ml(-1)) and 0.4 microg x kg(-1) of min(-1) of remifentanil. A small amount of rocuronium was also administered additionally until TOF ratio reached to 0%. Total amount of rocuronium was 20 mg (0.5 mg x kg(-1)) for intubation with a double-lumen tracheal tube. The duration of surgery was 68 min. We confirmed 84% recovery of TOF ratio 90 min after injection of rocuronium, and extubated the patient without reversal of rocuronium. We found that the maximum concentration in the plasma or effective site (Cp/Ce) of rocuronium was reached at the time of intubation.

Development of localized cul-de-sac endometrioid carcinoma associated with deep infiltrating endometriosis during remission of early endometrial cancer.

•A cul-de-sac endometrioid carcinoma adjacent to extraovarian endometriosis was identified during remission of endometrial cancer.•The origin of the cul-de-sac tumor was malignant transformation of deep infiltrating endometriosis.•Endometriosis-related cancer was identified in a woman with endometrial cancer during remission.•Hyperestrogenism due to infertility treatment may contribute to malignant transformation of deep infiltrating endometriosis.

Malondialdehyde generated from peroxidized linolenic acid causes protein modification in heat-stressed plants.

When polyunsaturated fatty acids (PUFAs) in biomembrane are peroxidized, a great diversity of aldehydes is formed, and some of which are highly reactive. Thus they are thought to have biological impacts in stressed plants; however, the detailed mechanism of generation and biochemical effects are unknown. In this study, we show that chloroplasts are major organelles in which malondialdehyde (MDA) generated from peroxidized linolenic acid modifies proteins in heat-stressed plants. First, to clarify the biochemical process of MDA generation from PUFAs and its attachment to proteins, we carried out in vitro experiments using model proteins (BSA and Rubisco) and methylesters of C18 PUFAs that are major components of plant biomembrane. Protein modification was detected by Western blotting using monoclonal antibodies that recognize MDA binding to proteins. Results showed that peroxidation of linolenic acid methylester by reactive oxygen species was essential for protein modification by MDA, and the MDA modification was highly dependent on temperature, leading to a loss of Rubisco activity. When isolated spinach thylakoid membrane was peroxidized at 37 degrees C, oxygen-evolving complex 33kDa protein (OEC33) was modified by MDA. These model experiments suggest that protein modification by MDA preferentially occurs under higher temperatures and oxidative conditions, thus we examined protein modification in heat-stressed plants. Spinach plants were heat-stressed at 40 degrees C under illumination, and modification of OEC33 protein by MDA was detected. In heat-stressed Arabidopsis plants, light-harvesting complex protein was modified by MDA under illumination. This modification was not observed in linolenic acid-deficient mutants (fad3fad7fad8 triple mutant), suggesting that linolenic acid is a major source of protein modification by MDA in heat-stressed plants.