[Cerebral infarction associated with esophagectomy: a report of a case].

We report a case of cerebral infarction developed either during or immediately after an operation. A 71-year-old man with esophageal cancer and a history of hypertension and asymptomatic cerebral infarction underwent right thoracolaparotomy for a subtotal esophagectomy. Anesthesia was maintained with a combination of 2% sevoflurane in oxygen and epidural analgesia using 2% mepivacaine. The operation was uneventful and the patient was transferred to ICU with the tracheal tube in place. On removal of the tracheal tube the next day the patient was unable to speak and his grip power of the right hand was weak. On CT a cerebral infarction was found in the left frontal lobe. A left carotid echogram showed a 90% constriction. The occlusion of the middle cerebral artery by an embolus detached from the constricted origin of the carotid artery was thought a most probable cause of the cerebral infarction. The presence of a carotid constriction must be explored preoperatively in aged patients scheduled to undergo extensive manipulations in the neck

[Perioperative administration of prostaglandin E1 inhibits post-operative serum bilirubin increase and preserves prothrombin time in patients with hepatocellular carcinoma and cirrhosis after laparoscopic microwave coagulation therapy].

BACKGROUND: Laparoscopic microwave coagulation therapy (LMCT) is indicated for the patients with hepatocellular carcinoma, especially when hepatic function is compromised. We retrospectively investigated the effects of perioperative administration of prostaglandin El on post-operative hepatic function in patients receiving LMCT. METHODS: Patients receiving LMCT for the treatment of hepatocellular carcinoma associated with compensated cirrhosis were included. Prostaglandin El administration was commenced after the induction of general anesthesia, with infusion rate at 0.01-0.02 microg x kg(-1) min(-1). Post-operative changes of serum albumin, serum total bilirubin, ALT, AST, lactate dehydrogenase, serum cholinesterase, platelet count, and percent prothrombin time were serially measured in patients with and without prostaglandin E1 administration. RESULTS: Perioperative prostaglandin El administration inhibited post-operative serum bilirubin increase and preserved prothrombin time compared to non-treated group. CONCLUSIONS: It was suggested that prostaglandin El possessed hepatoprotective property in compensated cirrhosis patients with hepatocelluar carcinoma receiving LMCT.