[Anesthetic Management of a Patient with Langerhans Cell Histiocytosis during Cesarean section].

Langerhans cell histiocytosis is a rare disease, associated with histiocyte increases, and granuloma, in various organs. About 160 patients are reported in Japan. A pregnant patient with a pulmonary Langerhans cell histiocytosis underwent cesarean section under spinal anesthesia. She had repeated pneumothorax with bilateral pulmonary cysts rapidly becoming worse during pregnancy. She was treated with continuous oxygen after 28 weeks of the pregnancy. On 34 weeks of the pregnancy, spinal anesthesia with 0.5% hyperbaric bupivacaine (2 ml) and fentanyl (25 µg) for cesarean section was performed, and provided excellent analgesia without any side-effects.

[Anesthesia management for cesarean section in a patient with placenta percreta].

Placenta accreta is a placental abnormality with a defect in decidua basalis. Villi tissue invades myometrium and it is difficult to exfoliate the placenta. Placenta percreta is a comparatively rare disorder in placenta accreta. This patient at pregnancy 14 weeks, exploratory laparotomy was performed for acute abdomen. At this time she was diagnosed as placenta percreta, but the pregnancy was continued. Caesarean section was scheduled in 37 weeks 0 days of pregnancy and combined spinal-epidural anesthesia was used. After the operation, we moved the patient to the angiography room to perform uterus artery embolization (UAE). While moving, we monitored maternal hemodynamics using a transportable monitor. During the cesarean section in the operation room, and in moving to the angiography room and in the angiography room, we used the same transportable monitor for secure perioperative management.

[One case of the basilar invagination that prevented tracheal intubation by Airway Scope].

Airway Scope (AWS, Pentax, Tokyo, Japan) is a very useful intubation assistance tool in the case where intubation is difficult with normal Macintosh laryngoscope. In this case, the operation was planned by general anesthesia in a patient with basilar invagination. We decided to intubate the patient using AWS because difficult tracheal intubation was expected. However, glottis was not confirmed even with AWS in the oral cavity, and we could not intubate with AWS. Therefore, we used a fiberscope, and endotracheal intubation was successful.

Propagation of Ca2+ release in cardiac myocytes: role of mitochondria.

Factors contributing to "local control" of Ca2+ release in cardiac myocytes are incompletely understood. We induced local release of Ca2+ by regional exposure of mouse atrial and ventricular myocytes to 10mM caffeine for 500 ms using a rapid solution switcher. Propagation of Ca2+ release was imaged by means of a Nipkow confocal microscope, and fluo-3. Under physiologic conditions, a local release of Ca2+ propagated in atrial myocytes, not in ventricular myocytes. Inhibition of SR Ca2+ uptake (500 nM thapsigargin), and of Ca2+ extrusion via Na/Ca exchange (5mM Ni2+), did not result in propagation in ventricular myocytes. The density of mitochondria was greater in ventricular than in atrial myocytes, although the abundance of ryanodine receptors and myofilaments was similar. Partial inhibition of Ca2+ uptake via the mitochondrial Ca2+ uniporter (5 microM Ru360) caused an increase in the [Ca2+]i transient in paced ventricular myocytes, and consistently resulted in propagation of Ca2+ release. This effect of Ru360 did not appear to be due to altered SR Ca2+ content. These data indicate that Ca2+ uptake via the mitochondrial uniporter occurs on a beat-to-beat basis, and may contribute to local control of Ca2+ release. Propagation of Ca2+ release in atrial myocytes may result in part from the relatively low density of mitochondria present.

[Effects of propofol on hepatic venous oxygen saturation--a comparison with isoflurane or sevoflurane anesthesia].

BACKGROUND: We performed a comparative study of propofol versus isoflurane and sevoflurane using continuous monitoring of hepatic venous oxygen saturation (ShvO2) during upper abdominal surgery in 26 patients. METHODS: Anesthesia was induced with propofol 2-2.5 mg x kg(-1) and vecuronium 0.1 mg x kg(-1). Thereafter, Swan Ganz catheters were inserted into the pulmonary artery and hepatic vein. Group P (n=26) patients received continuous propofol infusion and epidural mepivacaine injection for maintenance, while Group I (n=17) received isoflurane and Group S (n=9) received sevoflurane. Systemic oxygen extraction ratio (OERsys) and hepato-splanchnic oxygen extraction ratio (OERspl) were calculated. RESULTS: Heart rate, mean arterial pressure and cardiac index were unchanged after propofol infusion, and isoflurane or sevoflurane inhalation. Propofol at 8 and 10 mg x kg(-1) x h(-1) significantly decreased ShvO2 and increased OERspl, although isoflurane and sevoflurane did not change them. Mixed venous saturation and OERsys were within normal ranges during the studies. CONCLUSIONS: The results suggest that propofol increases the metabolism and oxygen consumption in the liver.

[Determination of cotinine in human urine by gas chromatograph-mass spectrometry].

A gas chromatograph-mass spectrometric assay has been developed for the quantitation of cotinine, the major metabolite of nicotine, in human urine. Extraction or condensing procedure was not required and the method reduced time involved in sample preparation. The analytes were separated on the fused-silica capillary column. The operating conditions were: injector, 250 degrees C; detector, 280 degrees C; column, 50-250 degrees C. The total gas flow-rate of helium (carrier) was 50 ml.min-1 and the pressure of column inlet was 100-200 kPa. The retention time was 18.1 min and the limit of quantitation was 5 ng.ml-1. This method provides an easy and simple assay for the detection of cotinine in clinical settings.