[Management of difficult airway during induction of anesthesia in a patient with Hallermann-Streiff syndrome].

An 18-year-old female with Hallermann-Streiff syndrome underwent the fixation of prolapsus recti. She had significant microgenia, mental retardation and pharyngeal airway stenosis. During induction of anesthesia with halothane and nitrous oxide, severe upper airway obstruction and respiratory depression occurred. The mask ventilation with jaw lift maneuver was impossible. Lowering anesthetic level restored her spontaneous breathing and airway patency. Although the direct laryngoscopic view under light anesthesia with halothane was limited to the epiglottic tip, blind orotracheal intubation using stylet was accomplish after several attempts. At the end of anesthesia, the tracheal tube was extubated after the patient had become fully awake and had recovered completely from neuromuscular blockade monitored by electromyography.

[Multiple cerebral infarction during anesthesia in a patient with hypergammaglobulinemia].

We experienced anesthetic management of two patients with hypergammaglobulinemia undergoing thoracoscopic lung biopsy, one of whom suffered from multiple cerebral infarction during anesthesia. Pathogenesis of this serious complication could not be elucidated. However, decrease in cerebral regional circulation caused by increase in blood viscosity would be most probable. We should preoperatively carry out measurement of blood viscosity and brain CT scan, and consider plasma exchange in patient with hypergammaglobulinemia, in whom symptoms and signs of hyperviscosity syndrome do not exist.

[Anesthesia for a patient with macrothrombocytopenia].

A 56-year-old female with macrothrombocytopenia was scheduled for colectomy and hepatectomy. She had not shown significant bleeding tendency. Her preoperative platelet counts were 0.5-1.6 x 10(4) microliters-1 with the use of an automated cell counter. However, microscopic examination showed platelet number ranging 0.9-3.4 x 10(4) microliters-1 and many macrothrombocytes. Therefore, platelet biomass (platelet number x platelet volume) seemed almost normal. Bleeding time was 3 minutes and platelet function was normal. She received preoperatively high dose gamma-globulin administration and intraoperatively platelet transfusion. The operation was performed under combined epidural and general anesthesia. Intra- and post-operative course was uneventful.

Modulation of the delayed K+ current by histamine in guinea pig ventricular myocytes.

The effects of histamine on delayed K+ current (IK) were investigated in patch-clamped single guinea pig ventricular myocytes. Histamine increased IK with a maximal fractional response of 2.7 and a kd of 9.4 x 10(-7) mol/l. At a concentration of 10(-8) mol/l, histamine did not increase IK significantly, but increased ICa by 52% +/- 12%. The voltage-dependence of IK activation, the reversal potential and the time course of the IK tail decay were not changed by histamine. Under pretreatment with 10(-4) mol/l of ranitidine, neither histamine (10(-6) mol/l) nor 2-pyridylethylamine (10(-4) mol/l) caused any sizable increase in IK. When the cell was pretreated with a saturating dose of isoproterenol (10(-6) mol/l), histamine did not additively enhance IK. The IK enhancement by 3 x 10(-7) mol/l histamine was partially antagonized by concurrent exposure to 5 x 10(-6) mol/l carbachol. Whereas, use of a higher concentration of histamine (10(-6) mol/l) obscured the inhibitory effect of carbachol. It is concluded that histaminergic action of IK is attributed exclusively to H2 receptor-mediated reactions involving GS protein and adenylate cyclase.

Opsoclonus-myoclonus syndrome with abnormal magnetic resonance imaging and brainstem auditory evoked potentials.

We describe two patients in encephalitis with opsoclonus-myoclonus syndrome. Cranial magnetic resonance imaging demonstrated an area of hyperintensity on the T2-weighted images in the left tegmentum at the pons level (case 1) and in the left tegmentum and partly basis at the upper pons level (case 2), respectively. On the other hand, brainstem auditory evoked potentials following left monaural stimulation and ipsilateral records revealed a delay of IIIrd wave latency and prolongation of I-III interpeak latencies (case 1). From these findings we suggest that the locus of the lesion of opsoclonus-myoclonus syndrome may partly exist in the brainstem (pontine tegmentum).

[Clinical studies on radical hysterectomy with preoperative external irradiation for stage III cancer of the cervix].

Full dose preoperative external irradiation was performed in cases of stage III cancer of the cervix (36 cases), and the effects were studied. The effects of preoperative irradiation on the operation, such as the time required for operation and the bleeding volume tended to be shorter and decreased, compared to stage III cases with postoperative irradiation (23 cases), and showed rather little difference when compared to cases of stage II with postoperative irradiation (85 cases). The postoperative effects, such as days required for the beginning of spontaneous urination, decrease in residual urine to less than 50 ml, and duration of fever (over 38 degrees C), did not differ from cases of stage III with postoperative irradiation, but there was a tendency to prolongation compared to cases of stage II. Histopathological examination of the specimen resected after the operation revealed that cancer parenchyma in the primary focus was influenced by irradiation in nearly 90% of cases, cancer cells showing degeneration and destruction with markedly decreased proliferative potentiality. Cases showing cancer infiltration into the vaginal stump and tip of the cardinal ligament were 8.3%, which was significantly lower than in stage III cases with postoperative irradiation. The frequency of metastasis to intrapelvic lymph node was 30.6%, significantly lower than 56.5% in stage III cases with postoperative irradiation, and lower than 36.5% in stage II cases. As to the postoperative complications raising clinical problems, disturbance of the urinary tract was noted in 52.8% and that of the rectum in 47.2%, but these complications became fatal in none.(ABSTRACT TRUNCATED AT 250 WORDS)