A case of pituitary metastasis discovered when diabetes insipidus developed in a patient 20 years after breast cancer treatment.

The patient was a 52-year-old woman. She had a history of left breast cancer at age 32 years, with no recurrences. She was examined for a feeling of oral dryness and nocturia, and central diabetes insipidus was diagnosed. A mass was seen in the posterior pituitary on magnetic resonance imaging, and multiple pulmonary nodules were seen on computed tomography. Breast cancer metastases were diagnosed in both tissues. Since this patient had no cancer other than the breast cancer treated 20 years earlier, it was difficult to reach a diagnosis of pituitary metastasis with pituitary gland imaging alone. In estrogen receptor-positive breast cancer, there may be recurrences after a long period of time. It may be that recommending a full body examination could be useful in the differential diagnosis of metastasis even in patients who have had a long disease-free period, if they had undergone surgery for breast cancer.

Impact of preoperative intervention for smoking cessation on postoperative length of stay and cost for spine surgery patients: Propensity score matching analysis.

BACKGROUND: Preoperative intervention for smoking cessation reduces the prevalence of postoperative complications in spine surgery. To date, however, the impact of these interventions on the length of stay (LOS) and cost for patients is unclear. PATIENTS/METHODS: This retrospective cohort study analyzed data from 317 patients who were current smokers and underwent spine surgery between January 2014 and December 2019 at a single facility in Tokyo, Japan. Most patients (262) received preoperative intervention for smoking cessation within 60 days before spine surgery; the remaining 55 patients did not receive the intervention. The postoperative LOS was compared using propensity score matching. Patients were matched for age, gender, body mass index, surgical plan (cervical surgery, anterior approach surgery, minimally invasive surgery), preoperative comorbidities (diabetes mellitus, hypertension, ischemic cardiac disease, chronic lung disease), and recent history of steroid therapy, which yielded 48 pairs of patients. RESULTS: The length of postoperative hospital stay was significantly shorter in the intervention group (-10.60 days, [95% CI, -15.79 to -5.42]). The cost for service was significantly lower in the intervention group (coefficient, Japanese yen [JPY] -1,515,529; [95% CI, -2,130,631 to -900,426]; 110 JPY equivalent to 1 United States dollar). CONCLUSIONS: Preoperative interventions for smoking cessation may decrease postoperative hospital stay and hospitalization costs.

Two cases of 18F-FDG-PET/CT positive Schloffer tumor following curative surgery of colon cancer.

We report two cases of Schloffer tumor that required resection after radical colon cancer surgery because of suspected lymph node recurrence on contrast-enhanced (CE) CT and 18F-FDG-PET/CT. Case1 is a 69-year-old man with sigmoid colon cancer pStage IIA, and case2 is a 61-year-old man with descending colon cancer pStage IIIB.

Bronchogenic cyst with atypical imaging findings and repeated ruptures in a short period of time: A case report.

Bronchogenic cysts are the most common primary cysts of the mediastinum. Although most are asymptomatic, some bronchogenic cysts cause symptoms such as chest pain and dyspnea. Here, we report a case of bronchogenic cyst that ruptured twice in a short period of time in a patient who presented with sudden back pain. The lesion was apparent on computed tomography (CT) as a mass lesion with heterogeneous and high attenuation in the posterior mediastinal region. CT-guided puncture performed for diagnostic purposes revealed the contents as bloody fluid. The patient suffered chest pain approximately 3 months after the first presentation, and re-growth and re-rupture of the mass was suspected. The lesion was surgically resected and pathologically diagnosed as a bronchogenic cyst. Spontaneous rupture is a very rare complication of bronchogenic cyst, usually into the trachea, pleural cavity, or pericardial cavity. However, there are no reports of multiple ruptures. This case highlights the importance of recognizing the atypical imaging findings of bronchogenic cyst and the rare complication of rupture.

Perioperative airway management of a 16-year-old boy with progressive airway obstruction due to juvenile nasopharyngeal angiofibroma.

Juvenile nasopharyngeal angiofibroma (JNA) involves difficult anesthetic management because of the risk of massive bleeding, while airway management is rarely a problem in JNA. This report presents an unusual case of JNA causing airway obstruction.

[Full Recovery from Cardiopulmonary Arrest caused by Traumatic Asphyxia].

Traumatic asphyxia is a crush injury of the chest characterized by facial edema, cyanosis, conjunctival hemorrhage, and petechiae on the face and chest. The prognosis depends on the duration of chest compression and early cardiopulmonary resuscitation after cardiopulmonary arrest. Here we report a case of full recovery from cardiopulmonary arrest caused by traumatic asphyxia. The chest of a 56-year-old man was compressed by a machine while working. Immediately, his colleague started cardiopulmonary resuscitation, which was successful. When he was admitted to our hospital, his consciousness level was E1V2M2(Glasgow coma scale). Our treatment included therapeutic hypothermia, the duration of which was 24 hours at 34 °C. Rewarming his body to 36 °C took place over 48 hours. Thereafter, he recovered completely and was discharged on the 12th hospital day without neurologic sequela. Therapeutic hypothermia was possibly effective in this case.

[A case report: perioperative management of adenotonsillectomy in a morbidly obese patient with severe obstructive sleep apnea syndrome].

A male patient in his thirties was scheduled to undergo adenotonsillectomy due to dyspnea from bilateral tonsillar hypertrophy. He was morbidly obese (body mass index 56 kg x m(-2)) with severe obstructive sleep apnea syndrome (OSAS), and thus was evaluated with extreme risk for difficult ventilation and intubation. We planned awake intubation via video-assisted laryngoscopy and fiberoptic bronchoscopy under dexmedetomidine sedation, and the intubation was successfully performed. After adenotonsillectomy, upper airway obstruction due to hemorrhage and oropharyngeal swelling can be life-threatening requiring emergent airway management. Thus for postoperative airway management, due to the possibility of "cannot intubate, cannot ventilate" (CICV) and presumed difficult tracheotomy, we scheduled to perform tracheotomy during adenotonsillectomy, right after anesthetic induction and awake intubation. On postoperative day 1, he started walking with no need of sedative drugs. On day 4, after confirmation of minimal oropharyngeal swelling, tracheal cannulae was removed, and no further complications were observed in his postoperative course. We conclude that careful preoperative evaluation of the airway, retention of spontaneous breathing via awake intubation, and preventive tracheotomy for postoperative airway management are important points in perioperative management of a morbidly obese patient with severe obstructive sleep apnea syndrome.

[The importance of preanesthetic evaluation: malignant tumors discovered on preoperative chest radiography, in patients scheduled for operation of benign tumors].

Preanesthetic evaluation is essential for the perioperative period. We report 2 preoperative patients with benign disease, whose preoperative chest radiography revealed intrathoracic malignant tumors. Case 1: A woman in her eighties with vascular necrosis of the femoral head was scheduled for bipolar hip arthroplasty under general anesthesia. On preanesthetic evaluation, widened mediastinum was detected on preoperative chest radiography. Instead of the scheduled operation, she underwent thoracoscopic surgery under general and epidural anesthesia. She was diagnosed with malignant thymoma. Case 2: A woman in her thirties with bilateral oviduct obstruction was scheduled for laparoscopic surgery. On preanesthetic evaluation, right middle lung lesion was detected. She underwent thoracoscopic biopsy under general and epidural anesthesia, and was diagnosed with malignant lymphoma. The result of preanesthetic chest radiography is reported to change the perioperative treatment only in 0.1%; our cases indicate the importance of preanesthetic evaluation of chest radiography in detecting possible underlying disease in the preoperative patient.