[A case of previously undiagnosed methemoglobinemia exhibiting sustained low SpO2 value at the induction of general anesthesia].

A 70-year-old woman was scheduled to undergo surgery for removal of thyroid tumor under general anesthesia. A routine preoperative evaluation confirmed that the patient was stable with no signs of cyanosis and dyspnea. However, during pre-oxygenation as well as mechanical ventilation with 100% oxygen, she showed sustained low SpO2 values (i.e., 91%). Arterial blood gas analysis at FIO2 of 1.0 showed an oxygen partial pressure (PaO2) of 297 mmHg. Unexpectedly, the analysis revealed methemoglobinemia (MetHb concentration: 15%) causing a discrepancy between the low SpO2 and normal PaO2 values in this patient. Methemoglobinemia is an uncommon cause of cyanosis; however, anesthesiologists should be aware that some drugs used during perioperative period (e.g., local anesthetics) can cause methemoglobinemia. While our case was a mild one and the patient recovered with no complications, methemoglobinemia levels above 30% could cause tissue hypoxemia and, thereby, requiring a treatment with methylene blue or ascorbic acid.

Somatostatin is involved in anorexia in mice fed a valine-deficient diet.

The ingestion of a valine (Val)-deficient diet results in a significant reduction of food intake and body weight within 24 h, and this phenomenon continues throughout the period over which such a diet is supplied. Both microarray and real-time PCR analyses revealed that the expression of somatostatin mRNA was increased in the hypothalamus in anorectic mice that received a Val-deficient diet. On the other hand, when somatostatin was administered intracerebroventricularly to intact animals that were fed a control diet, their 24-h food intake decreased significantly. In addition, Val-deficient but not pair-fed mice or those fasted for 24 h showed a less than 0.5-fold decrease in the hypothalamic mRNA expression levels of Crym, Foxg1, Itpka and two unknown EST clone genes and a more than twofold increase in those of Slc6a3, Bdh1, Ptgr2 and one unknown EST clone gene. These results suggest that hypothalamic somatostatin and genes responsive to Val deficiency may be involved in the central mechanism of anorexia induced by a Val-deficient diet.

Activity-dependent increase in beta-amyloid precursor protein mRNA expression in neurons.

Although beta-amyloid precursor protein (APP) has been suggested to play a role in neuronal survival and plasticity, the mRNA expression of APP has not been studied in terms of neuronal activity. In cultures of mouse cerebellar granule cells, we found that the levels of APP mRNA increased when a high concentration of potassium was present in the medium. A deprivation of membrane depolarization caused by lowering the K+ concentration decreased both mRNA expression and protein synthesis of APP. Increasing the concentration, however, restored mRNA expression, which was driven by the influx of Ca2+ through L-type voltage-dependent calcium channels and mediated by de novo protein synthesis. Thus, APP mRNA expression is controlled in an activity-dependent manner in neurons.