[A Case of EXIT (Ex-utero Intrapartum Treatment) in a Fetus with Prenatal Diagnosis of a Giant Cervical Tumor: Successful Airway Management but without Indication of Treatment for a Tumor].

The ex-utero intrapartum treatment (EXIT) is a rare procedure, and often comes as an emergency surgery. A careful preparation is crucial and a multidisciplinary team discussion during the prenatal period is necessary because it may be practically and ethically difficult to plan a surgical treatment for a fetus for EXIT. An elective caesarean section and EXIT for a fetus with a giant cervical tumor, which may cause airway obstruction and difficult intubation, were scheduled. The anesthesiologist tried oral intubation by direct laryngoscope; however, neither blade nor rigid bronchoscope insertion was impossible as a firm mass protruded in oral cavity from the left side. Tracheotomy was successfully performed and the airway was secured. As for maternal anesthesia, adequate uterine relaxation was obtained by inhalational agents and nitroglycerine. After ligation of the umbilical cord, anesthesia was maintained with propofol and fentanyl, and good uterine contraction was provided by infusion of oxytocin. The duration of EXIT was 44 minutes. The fetal tumor, containing both solid and cystic components, was 14 centimeters in diameter, and infiltrated into intracranial space. There was no indication of resection nor chemotherapy for the tumor. Palliative care was selected, and the neonate died forty days after birth.

[General anesthesia for pediatric cardiac magnetic resonance imaging].

The performance of MRI in children under 5 or 6 years of age usually requires sedation. Cardiac MRI takes even longer time to perform than regular MRI and such patients have cardiac diseases. It is therefore desirable for anesthesiologists to secure the airway and pay close attention to patients'vital signs. We perform general anesthesia for cardiac MRI using non-MRI-compatible monitors and anesthesia machines at our institution, and we therefore use appropriate devices to perform MRI safely. For that purpose, we either obtain peripheral intravenous access or perform tracheal intubation outside the MRI scan room and use extension cables for monitoring the patient.

Rev-erbalpha gene expression in the mouse brain with special emphasis on its circadian profiles in the suprachiasmatic nucleus.

Rev-erbalpha is an orphan nuclear receptor that constitutively suppresses gene transcription. In the present study, the expression of Rev-erbalpha was investigated in the mouse brain by in situ hybridization using antisense cRNA probe. Positive Rev-erbalpha mRNA signals were detected widely in the brain with the highest expression in the suprachiasmatic nucleus (SCN). In the constant dark condition, the circadian expression profiles of Rev-erbalpha m RNA in the SCN showed a peak at early daytime (CT4) and a trough at early night time (CT16). The environmental lighting condition (light-dark environmental condition and exposure in the subjective night) did not alter the expression profiles. These findings indicate that Rev-erbalpha gene is a transcription factor intimately related to the circadian clock in the SCN.