Syntheses of (-)-Tripterifordin and (-)-Neotripterifordin from Stevioside.

We report short syntheses of (-)-tripterifordin and (-)-neotripterifordin, potent inhibitors of HIV replication, from stevioside, a natural sweetener used worldwide. The key transformations are reduction at C13 through the formation of a tertiary chloride and subsequent three-step lactonization including a selective iodination at C20 by the photoreaction of the C19-alcohol. The title compounds were reliably obtained from stevioside in 9 and 11 steps (with 5-7 isolation steps), respectively. Additionally, the related lactone-containing ent-kaurenes, doianoterpenes A and B, and two more natural products were synthesized.

Anestheic Management of a Patient with Intravenous Leiomyomatosis Extending into the Right Atrium.

Intravenous leiomyomatosis (IVL) is a condition in which leiomyoma originating from uterine myoma or intrauterine venous walls develops intravenously. A single-stage operation was planned by the departments of gynecology and cardiovascular surgery for a patient in which the IVL was extended across the tricuspid valve. It was possible to safely perform perioperative care with continued evaluation of the tumor position and intravascular volume through the use of transesophageal echocardiography (TEE). TEE can be useful in the intraoperative care of patients with intracardiac tumor extension as in this case.

[The use of propofol combined with nitrous oxide and fentanyl in anesthetic management of a patient with mitochondrial encephalomyopathy].

A 49-year-old female with mitochondrial encephalomyopathy underwent surgery for implantation of an artificial cochlear device. She had some characteristic clinical features, including muscle weakness, deafness and dementia. Anesthesia was induced with 5 mg.kg-1 of propofol, and the trachea was intubated without a muscle relaxant. The patient was mechanically ventilated also without a relaxant, and anesthesia was maintained with a continuous infusion of 4-8 mg.kg-1.hr-1 of propofol, a bolus injection of 50-100 micrograms of fentanyl, and nitrous oxide (66%) in oxygen (33%). Bispectral index (BIS) was monitored and maintained at approximately 40. No cardiovascular instabilities or increase in plasma lactate concentration were observed during surgery. The patient had a smooth recovery from the propofol anesthesia, and the BIS value returned to the pre-anesthetic level 10 min after completion of the anesthesia, suggesting that the use of propofol is a safe means for inducing and maintaining anesthesia in patients with mitochondrial encephalomyopathy.