Jasmonoyl-l-isoleucine is required for the production of a flavonoid phytoalexin but not diterpenoid phytoalexins in ultraviolet-irradiated rice leaves.

Rice produces low-molecular-weight antimicrobial compounds known as phytoalexins, in response to not only pathogen attack but also abiotic stresses including ultraviolet (UV) irradiation. Rice phytoalexins are composed of diterpenoids and a flavonoid. Recent studies have indicated that endogenous jasmonyl-l-isoleucine (JA-Ile) is not necessarily required for the production of diterpenoid phytoalexins in blast-infected or CuCl2-treated rice leaves. However, JA-Ile is required for the accumulation of the flavonoid phytoalexin, sakuranetin. Here, we investigated the roles of JA-Ile in UV-induced phytoalexin production. We showed that UV-irradiation induces the biosynthesis of JA-Ile and its precursor jasmonic acid. We also showed that rice jasmonate biosynthesis mutants produced diterpenoid phytoalexins but not sakuranetin in response to UV, indicating that JA-Ile is required for the production of sakuranetin but not diterpenoid phytoalexins in UV-irradiated rice leaves.

[Continuous Interstitial Subcutaneous Fluid Glucose (ISFG) Measurement during Pre- and Intraoperative Periods for Highly Invasive Surgery].

BACKGROUND: Recently ERAS protocol has become common, and patients in our hospital drink preoperative oral fluid with carbohydrate nutrition. The present study evaluates interstitial subcutaneous fluid glucose (ISFG) with CGMS-Gold and ISFG variability is relevant to oral fluid. METHODS: The data was ISFG measurement with CGMS-Gold from 29 patients undergoing esophagus operation, liver resection, and pancreaticoduodenectomy in September 2011 to September 2012. We divided them into two groups. One was "preoperative (from having oral fluid to entering room) high ISFG group (H group : 11)" which showed preoperative peak ISFG over 200 mg x dl(-1). The other was "preoperative low ISFG group (N group: 18)" which showed preoperative peak ISFG under 200 mg x dl(-1). We compared preoperative and intraoperative (from entering to leaving room) peak ISFG in these groups. RESULTS: Preoperative peak ISFG was 267 ± 55 mg x dl(-1) in H group and 161 ± 16 mg x dl(-1) in N group. Intraoperative peak ISFG was 231 ± 75 mg x dl(-1) in H group and intraoperative peak ISFG was over 180 mg x dl(-1) in 9 patients. Intraoperative peak ISFG was 177 ± 50 mg x dl(-1) in N group and intraoperative peak ISFG was over 180 mg x dl(-1) in 7 patients. Preoperative high ISFG patients tended to show intraoperative high ISFG (P = 0.052); 6 patients were with diabetes mellitus and all the patients had pre- and intraoperative high ISFG. Thirteen patients without diabetes mellitus didn't show intraoperative high ISFG. CONCLUSIONS: This study suggested preoperative high ISFG group tended to show intraoperative high ISFG.

[Perioperative Management of a Patient with Hereditary Angioedema: A Case Report].

Hereditary angioedema (HAE) is a very rare disease that occurs in about 1 in 50,000 to 150,000 people. HAE is caused by low levels or inproper function of the plasma protein C1 inhibitor (C1-INH) which regulates activation of the complement system and the coagulation system. The typical symptom of HAE is regional swellings without pain nor itching, usually triggered by physical trauma or emotional stress. Unlike allergic edema, HAE attacks do not respond to antihistamines, corticosteroids noradrenaline. The swelling attacks against face and throat are potentially life-threatening, and should be treated as a medical emergency. We report a patient with HAE who underwent radical cystectomy of the upper gum under general anesthesia. Because the oral surgery with tracheal intubation is known to be a risk factor of laryngeal edema in a patient with HAE, she was given C1-INH before operation to prevent laryngeal edema according to HAE Guideline 2010 by the Japanese Association for Complement Research. Her pharynx and larynx were checked with Airwayscope before intubation and with bronchofiberscope before extubation, but no edema was recognized. Postoperatively, she was given C1-INH on the next morning again. She was discharged seven days after operation without any complications.

[An Adult Case of Difficult Intubation Caused by Late Complications of Radiotherapy for Pediatric Neck Malignancy, as well as a Later Laryngeal Elevation Surgery].

We present a case of a 32-year-old female who underwent endoscopic sinus surgery under general anesthesia. She had been diagnosed as rhabdomyosarcoma of her neck at 5 years of age, and received tumor resection and chemoradiotherapy. Afterwards, she was suffering from dysphagia as a late complication of radiotherapy. She received laryngeal elevation surgery at 24 years of age, in order to improve swallowing disturbance. With rapid induction of anesthesia, she was easily ventilated with mask and bag. However, it was difficult to visualize her vocal cord with various intubating apparatus, because of her mandible hypoplasia, small oral cavity, and laryngeal elevation. After all, we were able to intubate her trachea using Pentax Airway-scope® (AWS) with a Pediatric-type INTLOCK Blade™ (ITL-P). Radiotherapy for head and neck malignancy at childhood causes various late complications, leading to difficult intubation. Meanwhile, laryngeal elevation surgery for dysphagia anatomically makes intubation more difficult An adult who has such past history should be expected as an extremely difficult intubation case, and we must be prepared with various intubating apparatus including AWS with ITL-P.

[Comparison of the Pressure on the Larynx and Tongue Using McGRATH® MAC Video Laryngoscope--Direct Vision versus Indirect Vision].

BACKGROUND: Studies show that McGRATH® MAC (McG) is useful during direct laryngoscopy. However, no study has examined whether McG re- duces pressure on the upper airway tract We compared direct vision with indirect vision concerning pressure on the larynx and tongue. METHODS: Twenty two anesthesiologists and 16 junior residents attempted direct laryngoscopy of airway management simulator using McG with direct vision and indirect vision. Pressure was measured using pressure measurement film. RESULTS: In anesthesiologists group, pressure on larynx was 14.8 ± 2.7 kgf · cm(-2) with direct vision and 12.7 ± 2.7 kgf · cm(-2) with indirect vision (P < 0.05). Pressure on the tongue was 8.8 ± 3.2 kgf cm(-2) with direct vision and 7.6 ± 2.8 kgf · cm(-2) with indirect vision (P = 0.18). In junior residents group, pressure on larynx was 19.0 ± 1.3 kgf · cm(-2) with direct vision and 14.1 ± 3.1 kgf · cm(-2) with indirect vision (P < 0.05). Pressure on the tongue was 15.4 ± 3.6 kgf · cm(-2) with direct vision and 11.2 ± 4.7 kgf · cm(-2) with indirect vision (P < 0.05). CONCLUSIONS: McG with indirect vision can reduce pressure on the upper airway tract.

[Retrospective analysis of perioperative cardiovascular complications in patients with low left ventricular function undergoing noncardiac surgery].

BACKGROUND: Regarding patients for noncardiac surgery with low left ventricular function, we have little information about perioperative cardiovascular complications, making it difficult to evaluate such patients preoperatively and to inform them of their perioperative course. METHODS: We retrospectively investigated the patients undergoing noncardiac surgery under general anesthesia in our hospital from January 2008 to December 2011. The subjects were 52 patients with low left ventricular function defined as left ventricular ejection fraction under 40%. Patients with perioperative complications were compared with those without them in about 14 factors which might influence their perioperative course. RESULTS: Only one patient had severe hypotension intraoperatively. Postoperatively, five patients had cardiovascular complications in a week and three more in a month. Compared with those with complications and those without them, significant differences were found in 3 of 14 factors : type of surgery (P = 0.006), operation time (P = 0.013), and amount of intraoperative transfusion (P = 0.039). CONCLUSIONS: Regarding patients for noncardiac surgery with low left ventricular function, high risk of perioperative cardiovascular complications was found in a surgery which is highly invasive, long lasting, or requiring massive transfusion.

[Effects of preoperative oral carbohydrate administration on gastric contents].

BACKGROUND: Preoperative oral carbohydrate administration for adult patients has been recommended by European Society for Parenteral and Enteral Nutrition and Enhanced Recovery After Surgery. Although preoperative oral carbohydrate may improve patient satisfaction and perioperative glucose metabolism, its effects on the gastric contents remain controversial. METHODS: We included 232 adult patients without gastrointestinal stenosis or occlusion. Seventy-four patients (group A) were not permitted to eat or drink before operation for eight hours, while 158 patients (group B) took oral carbohydrate (225 ml, 22.3% glucose) two hours before anesthesia induction. After induction, gastric contents were aspirated to examine its volume and pH. RESULTS: Although the mean volume of gastric contents of the patients in group B was significantly lower than that in group A, and gastric pH was also significantly smaller in group B, no patients suffered from aspiration during rapid induction. Fasting interval and gastric volume were inversely related, and almost all the patients with fasting interval above 150 minutes showed gastric contents volume smaller than 25 ml and gastric pH more than 2.5. CONCLUSIONS: We conclude that preoperative oral carbohydrate can be given safely, although the fasting interval should be 150 minutes in our diet regimen.

[Perioperative management for a case of carotid artery stenting].

A 70-year-old male patient with severe cardiac dysfunction underwent carotid artery stenting for severe left carotid artery stenosis under monitored anesthetic care. He was sedated with propofol and fentanyl, and was monitored with ECG, pulse-oximeter and direct blood pressure measurement. He breathed spontaneously without severe hypoxia during the procedure. Followed by insertion of transient ventricular pacing wire against expected severe bradycardia, a guidewire was introduced into left internal carotid artery lesion via the right femoral artery. Soon after dilating the stenotic portion with a ballon catheter, sudden hypotension and bradycardia were recognized, which were successfully managed with bolus injections of vasoconstrictors and atropine sulphate. Even after stenting, hypotension continued for two days in spite of continuous administration of dopamine. Postoperative examination showed that the blood flow of the left carotid artery was doubled. Two weeks after the operation, he was discharged uneventfully.

[A case of the complications following glycerin enema which suggested malignant hyperthermia].

We experienced a case of the complications following glycerin enema which suggested malignant hyperthermia. A 73-year-old man with knee osteoarthritis was scheduled for total knee arthroplasty under general and epidural anesthesia. The patient received glycerin enema before surgery. After epidural catheterization, anesthesia was induced with thiopental, fentanyl, vecuronium and sevoflurane. The trachea was intubated and the patient was ventilated with sevoflurane-air-oxygen. Then, cola-like urine was drained and he became febrile up to 37.9 degrees C. Although there were no other symptoms suggesting malignant hyperthermia, the surgery was cancelled. We suspected not only hemolysis by the color of the serum and the blood chemistry, but also rhabdomyolysis by increased levels of serum creatine phosphokinase and myoglobin as well as urine myoglobin. He recovered uneventfully. On the third day, perirectal abscess and anal fissure were diagnosed, which were considered to be the cause of the fever. It is well-known that glycerin enema could cause hemolysis, but rabdomyolysis as a complication of glycerin enema has rarely been reported. We speculate that injection of hypertonic glycerin into the perirectal tissue could have caused rhabdomyolysis as well as hemolysis, which led to cola-like urine. The complications following glycerin enema can be incorporated to a differential diagnosis of malignant hyperthermia.