Acute limb ischemia by a pulmonary vein stump thrombus after left lower lobectomy: a case report.

BACKGROUND: Cases of systemic thromboembolism due to thrombus formation in the pulmonary vein stump after lobectomy have been reported recently. Cerebral infarction after left upper lobectomy is a common symptom in these cases. We encountered a rare case of acute limb ischemia caused by a thrombus formed in the left inferior pulmonary vein stump after left lower lobectomy. CASE PRESENTATION: A 62-year-old man underwent video-assisted left lower lobectomy under general anesthesia with epidural anesthesia. On postoperative day 2, he suddenly developed pain in the left calf. Contrast-enhanced computed tomography showed left popliteal artery occlusion and thrombus formation in the left inferior pulmonary vein stump. Anticoagulant therapy was started immediately, and emergent endovascular thrombectomy was performed. The patient recovered without complications. CONCLUSIONS: Left lower lobectomy can cause thrombus formation in the pulmonary vein stump, leading to systemic thromboembolism. Early detection and treatment are the keys to minimize complications.

Frequency-dependent changes in sensorimotor and pain affective systems induced by empathy for pain.

BACKGROUND: Empathy for pain helps us to understand the pain of others indirectly. To better comprehend the processing of empathic pain, we report the frequency-dependent modulation of cortical oscillations induced by watching movies depicting pain using high-density electroencephalography (EEG), magnetoencephalography (MEG), and motor evoked potentials (MEP). METHODS: Event-related desynchronization of EEG and MEG was assessed while participants viewed videos of painful (needle) or neutral (cotton swab) situations. The amplitudes of MEPs were also compared between the needle and cotton swab conditions. RESULTS: The degree of suppression in α/ß band power was significantly increased, whereas that of γ band power was significantly decreased, in the needle condition compared with the cotton swab condition. EEG revealed that significant differences in α/ß band were distributed in the right frontocentral and left parietooccipital regions, whereas significant γ band differences were distributed predominantly over the right hemisphere, which were confirmed by source estimation using MEG. There was a significant positive correlation between the difference in γ power of the two conditions and the visual analog scale subjective rating of aversion, but not in the α/ß band. The amplitude of MEPs decreased in the needle condition, which confirmed the inhibition of the primary motor cortex. CONCLUSION: MEP suppression supports that modulation of cortical oscillations by viewing movies depicting pain involves sensorimotor processing. Our results suggest that α/ß oscillations underlie the sensory qualities of others' pain, whereas the γ band reflects the cognitive aspect. Therefore, α/ß and γ band oscillations are differentially involved in empathic pain processing under the condition of motor cortical suppression.

Esophageal Submucosal Hematoma Possibly Caused by Gastric Tube Insertion Under General Anesthesia.

We present a case of an esophageal submucosal hematoma that developed after endovascular treatment for coil embolization for an unruptured cerebral aneurysm. The patient had received antiplatelet therapy before surgery and anticoagulation therapy during surgery. The orogastric tube was removed at case end with sustained negative pressure. After surgery, the patient reported chest and back pain and was diagnosed with an esophageal submucosal hematoma. The hematoma might have been related to the gastric tube insertion or removal. Providers should keep in mind the possibility of this complication when a patient who was given antithrombotic therapy reports chest or back pain after surgery.

[Anesthetic management for a patient with significant orthostatic hypotension probably due to pure autonomic failure].

A 73-year-old man with severe orthostatic hypotension was scheduled for open cholecystectomy. His blood pressure was 126/80 mmHg in the supine position and 50/30 mmHg in the upright posture. Preoperative autonomic function tests suggested that postsynaptic fibers of the sympathetic nervous system were impaired, and the disorder was probably due to pure autonomic failure. Anesthesia was induced with thiamylal and vecuronium, and maintained with sevoflurane (3%) and fentanyl (100 microg). Epidural anesthesia was used in the latter half of the operation. Meticulous use of vasoactive drugs such as dopamine and phenylephrine as well as adequate maintenance of systemic blood volume by infusion of a crystalloid solution enabled his hemodynamic condition to become stable during anesthesia.