Use of a laryngeal tube for sialolithotomy in a pediatric patient with left vocal cord paralysis: a case report.

BACKGROUND: The laryngeal tube (LT), a closed esophageal supraglottic device comprising pharyngeal and esophageal cuffs, is used for emergency airway management. However, it is not often used in intraoperative airway management. CASE PRESENTATION: A 9-year-old boy was scheduled for a sialolithotomy for sialolithiasis. He had a history of surgery for tetralogy of Fallot and had undergone vocal cord fusion for postoperative left-sided vocal cord paralysis. Following a strong request by the mother to avoid tracheal intubation to reduce the risk of bilateral vocal cord paralysis, management without intubation was initially considered in the preoperative anesthesia plan. Airway management was planned using an LT in case of ventilation failure due to positional abnormalities. Although some leakage was observed during intraoral surgery, it was quickly resolved by adjusting the position of the LT outside the sterile surgical field. CONCLUSIONS: The LT may be a viable option in cases where tracheal intubation is not preferred.

Interferon regulatory factor 7 mediates obesity-associated MCP-1 transcription.

Hypertrophy, associated with adipocyte dysfunction, causes increased pro-inflammatory adipokine, and abnormal glucose and lipid metabolism, leading to insulin resistance and obesity-related-health problems. By combining DNA microarray and genomic data analyses to predict DNA binding motifs, we identified the transcription factor Interferon Regulatory Factor 7 (IRF7) as a possible regulator of genes related to adipocyte hypertrophy. To investigate the role of IRF7 in adipocytes, we examined gene expression patterns in 3T3-L1 cells infected with a retrovirus carrying the IRF7 gene and found that enforced IRF7 expression induced the expression of monocyte chemoattractant protein-1 (MCP-1), a key initial adipokine in the chronic inflammation of obesity. CRISPR/Cas9 mediated-suppression of IRF7 significantly reduced MCP-1 mRNA. Luciferase assays, chromatin immunoprecipitation PCR analysis and gel shift assay showed that IRF7 transactivates the MCP-1 gene by binding to its proximal Interferon Stimulation Response Element (ISRE), a putative IRF7 binding motif. IRF7 knockout mice exhibited lower expression of MCP-1 in epidydimal white adipose tissue under high-fat feeding conditions, suggesting the transcription factor is physiologically important for inducing MCP-1. Taken together, our results suggest that IRF7 transactivates MCP-1 mRNA in adipocytes, and it may be involved in the adipose tissue inflammation associated with obesity.

Successful treatment of extensive spinal epidural abscess with fluoroscopy-guided percutaneous drainage: a case report.

BACKGROUND: Surgical drainage and antimicrobial therapy are the most accepted empirical treatments for spinal epidural abscess. However, surgery may not be indicated when patient's general health condition is poor. Percutaneous drainage has been reported as a non-surgical treatment for children or patients with no or minor neurological deficits. Here we describe the successful treatment of an extensive spinal epidural abscess with fluoroscopy-guided percutaneous drainage in an elderly man with progressive muscle weakness who could not be operated because of a poor general health condition. CASE PRESENTATION: An 81-year-old man presented with fever, back pain, and progressive muscle weakness in bilateral legs. Magnetic resonance imaging (MRI) showed extensive fluid retention in the spinal epidural space (Th6 to L3). Paraplegia due to an epidural abscess was suspected. We considered an emergency operation; however, the patient's general condition was poor. Therefore, fluoroscopy-guided percutaneous epidural drainage was performed. After drainage, his back pain and muscle weakness gradually resolved. After 3 weeks, MRI showed that the abscesses had completely disappeared. DISCUSSION: Compared with surgical drainage, fluoroscopy-guided percutaneous epidural drainage is a less invasive treatment option for patients with a poor general condition.

Successful anesthetic management during abdominal wall-lifting laparoscopic cholecystectomy in a patient with hereditary angioedema.

BACKGROUND: Hereditary angioedema is a rare genetic disorder resulting from an inherited deficiency or dysfunction of the C1-esterase inhibitor. In the anesthetic management of such patients, special caution should be exercised while attempting tracheal intubation because it may cause mucosal edema in the upper airway. CASE PRESENTATION: A 52-year-old female with hereditary angioedema was scheduled for laparoscopic cholecystectomy. C1-esterase inhibitor, Danazol, tranexamic acid, and prednisolone were administered on the day of surgery. An epidural catheter was inserted through the intervertebral space at T9/10, and spinal anesthesia was instilled via the L3/4 intervertebral space. A single-hole, Nishii-type lifting laparoscopic surgery, without pneumoperitoneum (i.e., gasless) was completed uneventfully. CONCLUSION: This report described the successful management of a patient with hereditary angioedema who underwent laparoscopic cholecystectomy using spinal-epidural anesthesia without tracheal intubation and lift type laparoscopic surgery. This approach to anesthetic management could be indicated in cases with a similar presentation.

[Pain treatment with low reactive level laser therapy (LLLT)].

Noninvasive and low reactive level laser (LLLT) is used as one of the light therapies without giving pain to the patient. Therefore, it is used often clinically in pain treatment, orthopedics, plastic surgery, dermatology, and dentistry. In the pain clinic field, it is one of the procedures indispensable to treatment of various pain including postherpetic neuralgia, diabetic neuropathy or myofascial pain. In recent years the mechanism has been gradually elucidated by basic study. The action is on sensory nerve, sympathetic nerve, blood vessel, immunity, inflammation and central nervous system, and is thought to contribute to analgesia. Also, many reports such as action to inhibit "itch", a promotor action of the bone metabolism, and the follicular maturation acceleration action have tested and elucidated these mechanisms, and will add further adaptation that will be new in future. Furthermore, development and downsizing of the free electron laser will promote elucidation of the low response level laser therapy. We expect much in the future of the LLLT.

[Hyperlactemia during undiagnosed pheochromocytoma resection under laparoscopy].

A 51-year-old man was scheduled to undergo adrenal tumor resection. Because his general physical findings and labolatory tests were not particular, and his serum concentrations of noradrenaline and adrenaline were within normal limit, the tumor was diagnosed as nonfunctional adrenal tumor. Anesthesia was induced with propofol, fentanyl and maintained with oxygen, air, propofol and remifentanil. When the surgeons started to work around the tumor, his blood pressure and heart rate increased suddenly. We decided to deal with the tumor as pheochromocytoma and started administering landiolol and prostaglandin E1. After the administration of the drugs, hemodynamic changes became stabilized; however, the increasing serum concentration of lactate continued until ligation of the adrenal vein. There were no clinical manifestations of circulatory failure and his liver function was within normal limits from his blood test. After the operation, we found his plasma concentration of adrenaline extremely high during the operation. Adrenaline increases blood lactate concentration due to metabolic effects. Hyperlactemia should be considered as one of the typical symptoms of pheochromocytoma.

[Anesthetic management for laparoscopic resection of adrenal pheochromocytoma in a woman with chronic renal failure].

A 52-year-old woman, undergoing hemodialysis for chronic renal failure over thirty years, developed pheochromocytoma. Her serum concentrations of noradrenaline (NA) and adrenaline were 5,330 pg x ml(-1) and 212 pg x ml(-1), respectively. She had often developed hypertensive crisis and also hypotensive crisis during hemodialysis, and quite often she had to give up continuing hemodialysis before its end. Anesthesia was induced by propofol, remifentanil and maintained with oxygen, air, propofol and remifentanil. Before starting operation, continuous hemodiafiltration (CHDF) was performed without any water removal. Although hypotension occurred temporarily after CHDF, severe hemodynamic changes were not observed during operation owing to NA substitution and infusion of 5% plasma protein fraction, and the operation was finished uneventfully. The molecular weight of NA is 169.18, and it can be filtered by CHDF. Because of removal of excessive NA by CHDF, we can avoid severe hemodynamic changes often observed in other case reports. CHDF was useful for anesthetic management of a patient with adrenal pheochromocytoma.

An unusual case of airway obstruction at the tip of an endotracheal tube caused by insertion of a nasogastric tube.

We report an unusual case of ventilatory impediment caused by the obstruction of an endotracheal tube (ETT) by a nasogastric (NG) tube. A 72-year-old woman with bronchial asthma was scheduled for colostomy closure. An ETT of 7.5-mm internal diameter (ID) could not be advanced, and finally a 5.0-mm ID ETT was placed, because she had post-intubation tracheal stenosis. When an NG tube was inserted after endotracheal intubation, ventilation suddenly became nearly impossible. She was treated for an asthmatic attack, but her respiratory condition did not recover. We then exchanged the ETT for a laryngeal mask airway (LMA) and removed the NG tube. It was suspected that the cause of the airway obstruction was that the NG tube in the esophagus compressed the membranous portion of the stenotic trachea and the tip of the ETT was obstructed.