[Fiberoptic tracheal intubation through the supraglottic airway device air-Q in a patient with Shprintzen-Goldberg syndrome].

We report a case of successful fiberoptic tracheal intubation through the supraglottic airway device air-Q in a 14-year-old boy in whom intubation was difficult because of Shprintzen-Goldberg syndrome. Shprintzen-Goldberg syndrome is a rare congenital disorder of connective tissue. The patient showed dysmorphic facies and weakness of connective tissue, and was scheduled to undergo abdominal surgery. After induction of general anesthesia, both attempts of laryngoscope-guided and AirwayScope -guided tracheal intubation failed, but a size-2 air-Q could be easily inserted. Fiberoptic tracheal intubation through the air-Q was successfully performed without any difficulty and was safe for his weak airway connective tissue. Supraglottic airway air-Q is a useful conduit for fiberoptic tracheal intubation under general anesthesia, especially in the case of a patient with weak connective tissue in whom intubation is difficult.

Maximum aortic diameter as a simple predictor of acute type B aortic dissection.

OBJECTIVES: To identify the most prognostic predictor of Stanford type B aortic dissection at admission. PATIENTS AND METHODS: Forty-three patients with Stanford type B aortic dissection were divided into two groups: (1) those who developed dissection-related events later (EV group: n = 18), including the need for surgery (n = 12), rupture (n = 1), dissection-related death (n = 5), and aortic enlargement > or =5 mm in diameter per year (n = 15); (2) those without later events (NoEV group: n = 25). Clinical features, aortic diameters, and blood flow status were compared. RESULTS: The maximum aortic diameter at admission was 41.5 +/- 1.7 mm for the EV group, which was significantly greater than the NoEV group (34.4 +/- 0.9 mm, p <0.001). A maximum aortic diameter > or =40 mm was found in 11 patients (61%) of the EV group, whereas this maximum was found in 4 (16%) of the NoEV group (p = 0.004). A patent false lumen at admission was found in all patients of the EV group and in 17 (68%) of the NoEV group (p = 0.013). Other factors were not significant. A Cox hazard analysis indicated a maximum aortic diameter > or =40 mm as a significant predictor for dissection-related events (hazard ratio 3.13, p = 0.032). The presence of a patent false lumen did not reach a statistical significance. CONCLUSION: Our results indicated that a maximum aortic diameter > or =40 mm at admission was the most prognostic factor for developing late dissection-related events, rather than the presence of a patent false lumen.

Septal myectomy, papillary muscle resection, and mitral valve replacement for hypertrophic obstructive cardiomyopathy: a case report.

We report a case of hypertrophic obstructive cardiomyopathy (HOCM) successfully treated with septal myectomy and mitral valve replacement (MVR) combined with a resection of the hypertrophic papillary muscles. The patient, a 74-year-old woman, first underwent the conventional septal myectomy through aortotomy. The papillary muscles revealed a marked hypertrophy, but extended myectomy and precise resection of the hypertrophic papillary muscles were thought to be difficult through the aortotomy. Through the right-sided left atriotomy, MVR and resection of the papillary muscles were additionally performed. The patient was smoothly weaned from the cardiopulmonary bypass, and the postoperative course was uneventful. The outflow pressure gradient was relieved to 0 mm Hg, from 94. The mean pulmonary artery pressure was reduced to 27 mm Hg, from 42. The patient has been doing well in the New York Heart Association (NYHA) functional class between I and II during 45 months of follow-up, without complications related to the use of a prosthetic valve. Septal myectomy is the procedure of choice in the surgical treatment of HOCM for most cases, but some may require additional mitral valve procedures. In patients with marked hypertrophic papillary muscles, MVR and resection of the muscles may be an option of treatment to ensure a relief of the outflow obstruction and to abolish systolic anterior movement in units with limited experience.

Idiopathic retroperitoneal fibrosis in a patient suspected of impending rupture of the abdominal aortic aneurysm.

Retroperitoneal fibrosis (RPF) is a relatively rare disease which shows a periaortic mass in the retroperitoneal area and predisposes to an obstructive uropathy. We report a case of idiopathic RPF occurring in a patient who was suspected of impending rupture of abdominal aortic aneurysm. A 60-year-old male, with a 2-week history of abdominal pain, was transferred for evaluation of the periaortic mass. Computed tomographic (CT) scan revealed radiological findings such as leakage of contrast media from the aortic lumen and expansion of the periaortic mass. The patient underwent laparotomy, which revealed retroperitoneal fibrotic plaques in the absence of aortic aneurysm. The pathological findings of the biopsy specimen were consistent with idiopathic RPF. The patient received ureteral stent placement and was treated with steroid therapy. When a similar case is encountered, our recommendations are as follows: (i) Both CT scan and magnetic resonance (MR) imaging should be performed to determine whether the retroperitoneal mass is due to idiopathic or secondary RPF. If idiopathic RPF is suspected, the patient should receive primary steroid therapy. (ii) Retroperitoneal periaortic mass indicates a need for the assessment of obstructive uropathy. Early placement of the ureteral stent is necessary for urinary decompression and preservation of the renal function in patients with obstructive uropathy.

[A comparison of combined spinal-epidural anesthesia with epidural anesthesia for postoperative pain relief after transurethral resection of the prostate].

BACKGROUND: We compared combined spinal-epidural anesthesia (S group) and epidural anesthesia (E group) in terms of pain control after transurethral resection of the prostate (TUR-P). METHODS: All 32 patients received 0.2% ropivacaine at a rate of 2 ml x hr(-1) by a portable disposable pump postoperatively. RESULTS: S group was superior to E group in urethral pain control within three hours after operation. E group was superior to S group in decrease of back pain over six hours after operation. Fifteen patients (47%) suffered from irritability or low back pain and needed rescue analgesics. CONCLUSIONS: Our result indicates that 0.2% ropivacaine at a rate of 2 ml x hr(-1) is not satisfactory to relieve the postoperative pain. Long acting local anesthetics for spinal anesthesia are not suitable for TUR-P. Supplemental administration of opioid to epidural space or higher rate of continuous epidural infusor after operation might be better analgesic choice for TUR-P.