[Effectiveness of indocyanine green fluorescence in endoscopic marking in gastric cancer surgery:a feasibility study for replacing India ink].

When injected, indocyanine green (ICG) immediately combines with lipoproteins to fluoresce. Here, we studied whether ICG fluorescence is effective for endoscopic marking in gastric cancer surgery using a photodynamic eye (PDE) camera and fluorescent endoscope. An ICG solution was endoscopically injected into the submucosal layer of the gastric tumor 3 days before surgery. We observed the lesions using both a PDE camera and a fluorescent endoscope during laparotomy and laparoscopy, respectively;we also observed the fluorescent luminance and fluorescent size of the resected lesions. We could intraoperatively detect the size of the resected lesions in eight patients with early gastric cancer and six patients with advanced gastric cancer. We believe that the use of ICG fluorescence in endoscopic marking requires additional information, such as the volume of the ICG solution and the timing of the ICG injection.

Intraoperative localization of arteriovenous malformation of a jejunum with combined use of angiographic methods and indocyanine green injection: Report of a new technique.

INTRODUCTION: The localization of small intestine sources of obscure gastrointestinal bleeding has been a challenge. The use of indocyanine green (ICG) is effective in aiding intraoperative localization if a bleeding lesion is identified on angiography. CASE PRESENTATION: A 95-year-old Japanese man presented with hematochezia. Selective angiography of the superior mesenteric artery (SMA) established an arteriovenous malformation (AVM). ICG injection into the feeding vessel was administered intraoperatively, and the demarcated segment of the jejunum was resected. DISCUSSION: Diluted ICG was injected in the SMA by intraoperative angiography, and the region could be easily and clearly visualized by the ICG fluorescence imaging; small patchy poolings of ICG were recognized. Ultimately, the region was diagnosed as an AVM of the jejunum. To the best of our knowledge, this is the first reported description of this technique. CONCLUSION: Our new technique of combining selective angiography with intraoperative ICG injection and focused enterectomy is a safe, accurate, and cost-effective treatment.

Rectal obstruction due to endometriosis: A case report and review of the Japanese literature.

INTRODUCTION: Colorectal obstructive endometriosis is relatively rare in Japan and its differentiation from malignancy is often difficult. We report a case of rectal obstructive endometriosis. PRESENTATION OF CASE: A 37-year-old woman was referred to our hospital with a suspected ileus. Her chief symptoms were left lower abdominal pain and vomiting. Colonoscopy showed an intraluminal mass of redness in the upper rectum. A proctectomy was performed because of the bowel obstruction. The rectum was filled with an intraluminal mass measuring 5cm×4cm, and endometriosis was diagnosed pathologically. DISCUSSION: A preoperative diagnosis of colorectal obstructive endometriosis is often difficult because of the lack of definite diagnostic, clinical, sonographic, or radiological findings that are characteristic of this disease. Medical treatment is not always effective for colorectal obstructive endometriosis, and surgery is often performed. CONCLUSION: Colorectal obstructive endometriosis should be considered as a differential diagnosis in cases of various gastrointestinal symptoms in women who are of reproductive age.

Propofol inhibits long-term potentiation but not long-term depression in rat hippocampal slices.

BACKGROUND: Although propofol is known to produce amnesia when used for anesthesia, mechanisms underlying its effects on memory are poorly understood. The current study was designed to examine the effects of propofol on forms of synaptic plasticity thought to contribute to memory processing. METHODS: Extracellular excitatory postsynaptic potentials were recorded from the CA1 region of rat hippocampal slices. Long-term potentiation (LTP) was induced using theta-burst stimulation (10 bursts of 4 pulses at 100 Hz, applied at 5 Hz) of the Schaffer-collateral pathway, while low-frequency stimulation (1 Hz x 900 pulses) was delivered to induce long-term depression. The authors also used higher-frequency stimulation (10 bursts of 4 pulses at 200 Hz, applied at 5 Hz) in the presence of MK-801 to examine the effects of propofol on an N-methyl-D-aspartate receptor-independent form of LTP. RESULTS: At 30 microM, propofol inhibited LTP induction produced by theta-burst stimulation but had less effect on LTP maintenance. Similarly, when LTP was induced by 200-Hz stimulation in the presence of MK-801, propofol also blocked LTP induction. Propofol did not block LTP induction in the presence of picrotoxin, a specific antagonist of gamma-aminobutyric acid type A receptors, suggesting that modulation of gamma-aminobutyric acid type A receptors participates in propofol-mediated LTP inhibition. Propofol did not inhibit long-term depression. CONCLUSIONS: Propofol inhibits LTP induction through modulation of gamma-aminobutyric acid type A receptors but not via inhibition of N-methyl-D-aspartate receptors. However, other factors also possibly contribute to propofol-mediated LTP inhibition.

A prospective evaluation of anesthesia for posterior lumbar spine fusion: the effectiveness of preoperative epidural anesthesia with morphine.

STUDY DESIGN: A prospective, randomized, single-blinded study. OBJECTIVES: To prospectively compare the anesthesia for posterior lumbar spinal fusion between the age- and gender-matched groups with and without preoperative epidural anesthesia with morphine. SUMMARY OF BACKGROUND DATA: To reduce the blood loss, hypotensive anesthesia is frequently used in the spinal fusion. However, in spite of administration of the hypotensive agents, inadequate analgesia during operation often causes unfavorable and unexpected elevation of blood pressure resulting in excessive bleeding. As well, intractable wound pain sometimes occurs after spinal fusion due to inadequate analgesia during surgery. METHODS: Forty cases of posterior lumbar spinal fusion were investigated prospectively. Twenty patients underwent preoperative epidural anesthesia with morphine and sedation by continuous intravenous administration of propofol but without administration of any kind of anesthetics, including intraoperative and/or postoperative epidural anesthesia (Group E). Another 20 patients underwent inhalation general anesthesia with sevoflurane and intermittent intravenous administration of fentanyl without any regional block (Group F). In these groups, dynamics and average mean blood pressure during surgery, blood loss during surgery, postoperative requirement of analgesics, the visual analogue scale, and accuracy of neurologic evaluation immediately after surgery were analyzed. RESULTS: The average mean blood pressure during surgery was significantly lower in Group E than Group F: 57.1 mm Hg and 72.8 mm Hg, respectively. In addition, the dynamics of blood pressure were more stable in Group E than Group F. The blood loss during surgery was significantly less in Group E than in Group F: 546 g and 631 g, respectively. The patients of Group E required analgesics after surgery less frequently, and the rating on the visual analogue scale was significantly lower in Group F on the first, second, and third days after surgery. It was difficult to evaluate the neurologic status accurately in 5 patients of Group F because of the inadequate emergence immediately after surgery. There were no patients in Group E whose neurologic status was unclear because of the paralysis caused by epidural anesthesia. CONCLUSIONS: To combine preoperative epidural anesthesia with other anesthetic procedure for spinal fusion contributes to maintain more stable hypotension during surgery. As a result, it will be possible to lessen the bleeding during surgery. In addition, the postoperative pain was easily controlled with administration of fewer analgesic agents in patients who underwent the epidural anesthesia. The effectiveness of pre-emptive analgesia should be emphasized to diminish the postoperative pain.

[Investigation on nurses' knowledge of and experience in cardiopulmonary resuscitation and on nurses' knowledge of the guidelines for cardiopulmonary resuscitation and emergency cardiovascular care established in 2000--results of a survey at Asahikawa Medical College Hospital (second report)].

BACKGROUND: We reported that the practical knowledge and skill on basic life support were not enough among nursing staffs. Therefore, to clarify the existing conditions and issues in CPR education we carried out a survey on knowledge of and experience in cardiopulmonary resuscitation (CPR) and on knowledge of the Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (ECC) established in 2000. METHODS: Three hundred and four nurses at Asahikawa Medical College Hospital were asked to fill in questionnaires. RESULTS: The results show that more than 80% of the nurses are much interested in CPR. Most of the nurses had received education and training in CPR as students or after graduation. However, cases of cardiopulmonary arrest and CPR were experienced by only about 40% of the nurses. Most of the nurses had never heard of the Guidelines for CPR and ECC in 2000. CONCLUSION: The results of this survey demonstrate the need to provide more education (on CPR) to nursing staff.

Effects of right stellate ganglion block on the autonomic nervous function of the heart: a study using the head-up tilt test.

The effect of peripheral sympathetic block on the autonomic nerve function of the heart was studied using the head-up tilt test (HUTT) and right stellate ganglion block (RSGB). Blood pressure (BP), heart rate (HR) and the parameters of power spectral analysis of HR variability recorded during the HUTT were measured in 8 patients with chronic pain syndrome before and after RSGB. In the control state, the mean HR and the LF/HF component recorded during HUTT significantly increased whereas the HF component markedly decreased. Conversely, the mean HR and LF/HF and HF components during HUTT did not significantly alter after the RSGB procedure. There were no significant differences between the BP values before and after RSGB. These results suggest that RSGB suppresses cardiac sympathetic function without significantly affecting BP and thus may be a safe and effective therapy for the chronic pain syndrome.

[A survey on cardio-pulmonary resuscitation knowledge of the nursing staff in the Asahikawa Medical College Hospital].

We surveyed the knowledge of the 66 nursing staffs on cardio-pulmonary resuscitation (CPR) and compared the results with that of 53 students of the Department of Nursing of the Asahikawa Medical College. The average scores of the test among the nursing staffs and the student nurses were 61 points and 54 points, respectively. Although a significant difference in the percentage of total correct answers was demonstrated between the two groups, the rate of correct answers of the observation items was high, whereas that of skill items was comparatively low in each group. The "Ability" defined as an indicator of capability of practicing CPR of the nursing staffs was 17% and that of the student nurses was 0%. Our results show that the CPR knowledge of both the nursing staffs and the student nurses was not sufficient, indicating the necessity of CPR education for both nursing staffs and student nurses.

[Anesthetic management for elective cesarean section due to placenta previa in a patient with moyamoya disease].

We report the anesthetic management of a 31-year-old female patient with moyamoya disease using general anesthesia combined with epidural anesthesia for a cesarean section due to placenta previa. Epidural anesthesia with 10 ml of 2% lidocaine was first used. Then general anesthesia was induced with thiamylal 200 mg and succinylcholine 60 mg just before starting operation and was maintained with 60% nitrous oxide in oxygen. After the delivery, propofol was administered at 3-5 mg.kg-1.hr-1. Except for temporary hypotension due to massive bleeding, systolic blood pressure was maintained between 100 and 120 mmHg. Arterial carbon dioxide tension was maintained at about 40 mmHg. Intracranial blood velocity and regional oxygen saturation were also measured to monitor cerebral blood flow. There was no postoperative pain, and no postoperative neurological defects. On the basis of these findings, it was concluded that general anesthesia combined with epidural anesthesia for elective cesarean section due to placenta previa is effective for perioperative management of a patient with moyamoya disease.