Presumed primary malignant melanoma of the liver: a case report.

A 55-year-old woman was hospitalized with a palpable and painful mass in her upper abdomen. Abdominal computed tomography revealed a 10 × 7-cm tumor extending into the abdominal cavity from the left hepatic lobe and multiple metastatic lesions in the right hepatic lobe. A left hepatic lobectomy was performed for debulking and palliative resection.

Factors predictive of survival after percutaneous endoscopic gastrostomy in the elderly: is dementia really a risk factor?

Objectives: Outcomes, especially survival, after percutaneous endoscopic gastrostomy (PEG) in patients with dementia remain unclear. The aims of this study were to assess the impact of dementia on survival after PEG and to explore the risk factors in elderly patients.

Methods: A total of 311 consecutive Japanese patients who underwent PEG were enrolled in this retrospective cohort study.

[Asystole after anesthetic induction with remifentanil].

A 45-year-old man was scheduled for laparoscopic cholecystectomy. He had hypertension controlled with beta-adrenergic, calcium channel and angiotensin II receptor blocking agents. Because he had complications of symptomatic cervical spondylosis and sleep apnea syndrome, we performed awake fiberoptic intubation with remifentanil at a dose of 0.

[Anesthetic management of patients 100 years of age and above undergoing emergency abdominal surgery].

We anesthetized four patients aged 100 years and above who underwent emergency abdominal surgery. Case 1 : A 100-year-old woman with ileus caused by rectal cancer had chronic heart failure in whom colostomy was performed. Case 2 : A 101-year-old man with incarceration of inguinal hernia and history of cerebral infarction.

[A case of carcinosarcoma of the esophagus treated by the chemoradiotherapy].

A 82-year-old man was admitted into our hospital complaining of dysphagia. Endoscopic examination revealed an elevated tumor in the middle esophagus, and biopsy revealed carcinosarcoma. He underwent chemo-radiotherapy, and the size of tumor decreased remarkably and almost disappeared 7 months later.

Old-fashioned but modern tube cervical esophagostomy.

Background: Nasogastric tubes (NGT) are used widely for feeding and decompressions of stomach, but they are associated with several complications and discomfort. When prolonged use of NGT is required, percutaneous endoscopic gastrostomy (PEG) should be considered. However, PEG is not feasible for patients with previous gastrectomy.

Aortic stiffness is an independent determinant of B-type natriuretic peptide in patients with coronary artery disease.

Previous studies demonstrated that the B-type natriuretic peptide (BNP) level is high in some patients with coronary artery disease (CAD) despite a preserved left ventricular function, although the mechanism underlying this increase in patients with CAD has not been fully elucidated. Because aortic stiffness is greater in patients with CAD and increases with CAD severity, there is a possibility that an increased aortic stiffness in turn increases the elevation of the BNP level in patients with CAD. In this study, we measured BNP level and brachial-ankle pulse wave velocity (baPWV) in 134 patients with CAD, and evaluated the relationship between BNP and baPWV.

[Combined paravertebral lumbar plexus and parasacral sciatic nerve block for reduction of hip fracture in four patients with severe heart failure].

We experienced four cases of anesthesia for hip fracture reduction in patients with severe heart failure, where anesthesia was attempted with combined paravertebral lumbar plexus and parasacral sciatic nerve block instead of spinal anesthesia. The anesthesia was successful without any sequelae. The patients' characteristics are as follows.

[Which anesthetic technique is more suitable for hip fracture surgery in patients above the age of 85, spinal or epidural?].

Background: Anesthesia for hip fracture in elderly patients is a challenge because of their reduced functional reserve. We compared spinal and epidural anesthesia retrospectively in the operations of hip fracture in patients above the age of 85.

Methods: Two hundred and eighteen operations from April 1995 to September 2003 in our hospital were examined.

Aortic stiffness is an independent predictor of left ventricular function in patients with coronary heart disease.

Although aortic stiffness plays an important role in patients with coronary artery disease (CAD), the influence of aortic stiffness on left ventricular systolic function has not yet been fully evaluated. In the present study, we measured brachial-ankle pulse wave velocity (baPWV), which is a new index of aortic stiffness, in patients with CAD (CAD group, n = 170, 67 +/- 9 years old) and without CAD (non-CAD group, n = 81, 63 +/- 8 years old), and evaluated the relationship between baPWV and left ventricular systolic function in patients with CAD. baPWV in the CAD group was significantly higher than that in the non-CAD group (1,794 +/- 350 vs.

[A case of re-expansion pulmonary edema after one lung ventilation for the radical operation of lung cancer].

A 64-yr-old man was admitted to our hospital for the examination of the abnormal shadow in his left lung field, which was diagnosed later as lung cancer. Radical operation was scheduled under combined epidural/general anesthesia. One lung ventilation was performed to facilitate the operative procedure for two hours and fifteen minutes.

A new technique for muscle flap closure of the empyema space in complicated chronic bronchopleural fistula. Wedging the causative bronchus with a plug.

Objectives: It is difficult to close the empyema space once it is opened, especially in cases complicated with a chronic bronchopleural fistula. A muscle flap closure is generally employed to prevent this situation. However, this operation occasionally fails because the space newly recurs around the fistula due to atrophic change occurring in these translocated muscles.

[Awake pronation of surgical patients with cervical spinal lesions].

Positioning of patients with cervical spinal lesions under general anesthesia may lead to serious neurological complications. The authors attempted awake pronation in eighteen patients to minimize the risks. In all patients, cervical instability or cervical spinal cord compression was diagnosed, and posterior fusion or laminoplasty under general anesthesia was planned.

Ratio of branched chain amino acid to tyrosine after hepatectomy.

The roles of branched chain amino acids (BCAAs) and the tyrosine (Tyr) profile after liver resection were investigated using an inexpensive enzymatic method that was recently developed to quantify their concentrations. The preoperative BCAAs-to-Tyr ratio (BTR) was significantly correlated with the preoperative indocyanin green clearance ratio. The BTR decreased immediately after surgery in all patients, but it was significantly lower in those who had undergone major hepatectomies.

[A patient who recovered successfully from severe anemia which continued for one hour].

A 79-year-old woman had her cervical spinal cord injured and laminoplasty of the neck was performed. Uncontrollable venous bleeding was encountered during the operation and about 5000 ml of blood was lost in one hour. Massive infusion of 5% albumin and hydroxyethylstarch (HES) was done to maintain the intravascular volume.

[Clinical characterization of allergic patients sensitized to Chamaecyparis obtusa--using AlaSTAT system].

Clinical characterization of patients with allergy to Chamaecyparis obtusa (Cypress) pollen and their specific IgE antibody was investigated by using AlaSTAT assay, a new method for measurement of antigen-specific IgE antibody. Positive rate of antigen-specific antibody in patients with allergic pollinosis was 83.5% for Japanese cedar pollen and 80.