[Use of temporary aortic balloon occlusion of the abdominal aorta was useful during cesarean hysterectomy for placenta accreta].

We describe the use of an abdominal aortic occlusion balloon catheter to control excessive blood loss at cesarean hysterectomy for placenta accreta. Prophylactic abdominal aortic occlusion balloon catheter was placed in the angiography suite under local anesthesia before surgery. The 38-year-old parturient was anesthetized with propofol, sevoflurane, ketamine, remifentanil and fentanyl under close monitoring and appropriate respiratory management. The occlusion balloon was inflated after the infant had been delivered, and bleeding at the placenta required cesarean hysterectomy. There was a sudden and dramatic reduction in blood loss, and hysterectomy was performed uneventfully. An aortic occlusion was sustained for 25 min. Intraoperative blood loss was 1,800 g, and 300 g of autologous blood and 4 units of red cell concentrates were transfused. The postoperative course was uneventful. The present case suggests that prophylactic insertion of an aortic occlusion balloon catheter seems to be a safe and an effective method in controlling anticipated bleeding for caesarean hysterectomy in a parturient with placenta accreta.

Voiceless affricate/fricative distinction by frication duration and amplitude rise slope.

Previous psychophysical studies have shown that the perceptual distinction between voiceless fricatives and affricates in consonant-vowel syllables depends primarily on frication duration, whereas amplitude rise slope was suggested as the cue in automatic classification experiments. The effects of both cues on the manner of articulation between /integral of/ and /t integral of/ were investigated. Subjects performed a forced-choice task (/integral of/ or /t integral of) in response to edited waveforms of Japanese fricatives /integral of i/, /integral of u/, and /integral of a/. We found that frication duration, onset slope, and the interaction between duration and onset slope influenced the perceptual distinction. That is, the percent of /integral of/ responses increased with an increase in frication duration (experiments 1-3). The percent of /integral of/ responses also increased with a decrease in slope steepness (experiment 3), and the relative importance between slope portions was not even but weighted at onset (experiments 1 and 2). There was an interaction between the two cues of frication duration and steepness. The relative importance of the slope cue was maximum at a frication duration of 150 ms (experiment 3). It is concluded that the frication duration and amplitude rise slope at frication onset are acoustic cues that discriminate between /integral of/ and /t integral of/, and that the two cues interact with each other.

[Anesthetic management of two patients with the history of SMON].

Patients of subacute myelo-optico-neuropathy (SMON) suffer from neurological disorders for a long time. The authors report anesthetic management of two patients with SMON. One patient was a 82-year-old woman suffering from SMON for 49 years. Sensory examination revealed numbness and hypesthesia in the both lower extremities. She underwent open reduction for femoral neck fracture. The other patient was a 91-year-old man suffered from SMON for 31 years. Sensory examination revealed weakness of leg muscles. He underwent transurethral resection of prostate. We chose general anesthesia for both patients instead of spinal anesthesia because of reported complications related to spinal anesthesia in patients with the disease. Intraoperative courses were uneventful and there were no neurological deteriorations postoperatively in both patients. One of the chief symptoms of patients with SMON is numbness of the lower extremity. Therefore patients of SMON may feel uncomfortable to the numbness by spinal or epidural anesthesia. This is the main reason we recommend general anesthesia for patients with SMON.