Alveolar hypoventilation exists by definition when arterial PaCO2 increases above the normal range of 37 to 42 mmHg, but in clinically important hypoventilation syndromes PaCO2 is generally in the range of 50 to 80 mmHg. The management of chronic hypoventilation must be individualized to the patient's particular disorder, circumstances and need. This is a case report of anesthetic management of a 63-year-old woman with central alveolar hypoventilation (CAH) secondary to cerebral infarction. For hip surgery epidural anesthesia with 0.5% bupivacaine was performed and doxapram was applied to maintain respiratory drive. The anesthetic experience with a brief review of literature is reported.
Anesthesia, Epidural ; Bupivacaine ; Cerebral Infarction ; Doxapram ; Female ; Hip ; Humans ; Hypoventilation* ; Middle Aged ; Reference Values ; Sleep Apnea, Central

BACKGROUND: Increasing coronary perfusion pressure with phenylephrine is important treatment strategies for right ventricular dysfunction caused by pulmonary hypertension. We compared the effects of phenylephrine on systemic and pulmonary hemondynamics in patients with and without pulmonary hypertension. METHODS: Twenty patients undergoing a valvular replacement were divided into two groups according to pulmonary artery pressure (PAP): control group (mean PAP < 25 mmHg, n = 9) or pulmonary hypertension group (mean PAP > 25 mmHg, n = 11). When systolic blood pressure decreased below 100 mmHg after the induction of anesthesia, phenylephrine was infused to raise systolic blood pressure up to 30% and 50% over baseline. Hemodynamic variables were measured at each time. RESULTS: Phenylephrine failed to raise systolic blood pressure up to 50% above baseline in more than half of the patients with pulmonary hypertension in contrast to successful increases in all patients without pulmonary hypertension. However, the ratio of PAP to systolic blood pressure was significantly reduced in patients whose systolic blood pressure was successfully increased up to 50% over baseline in the pulmonary hypertension group whereas the PAP concomitantly increased as systolic blood pressure was increased in the control group. CONCLUSIONS: Phenylephrine couldn't increase systolic blood pressure in some patients with pulmonary hypertension unlike in control group and it seemed to occur more often in patients with greater the ratio of PAP to systolic blood pressure. The baseline systemic vascular resistance index was high and cardiacoutput was low in the pulmonary hypertension group and these conditions seemed to restrict the effect of phenylephrine.
Anesthesia ; Blood Pressure ; Hemodynamics* ; Humans ; Hypertension, Pulmonary* ; Perfusion ; Phenylephrine* ; Pulmonary Artery ; Vascular Resistance ; Ventricular Dysfunction, Right

This case involves a 43-year-old man who had been diagnosed as having Charcot-Marie-Tooth disease (CMTD) 9 years ago and was scheduled to undergo posterior fusion of its spine due to a compression fracture. General anesthesia using propofol was selected as the anesthetic method, in order to avoid the occurrence of malignant hyperthermia due to inhalation anesthetics. The patient was given 100 mg of propofol for anesthetic induction, and then propofol was infused at a rate of 4-5 mg/kg/h with intermittent administration of fentanyl for anesthetic maintenance. Rocuronium 50 mg was injected for endotracheal intubation, and then rocuronium 10 mg was injected at 45 min intervals. There was no delay in awakening, and the patient experienced no problems postoperatively. Intravenous anesthesia using propofol is thought to be a safe and effective method of anesthesia for patients with CMTD.
Adult ; Anesthesia ; Anesthesia, General ; Anesthesia, Intravenous ; Anesthetics, Inhalation ; Charcot-Marie-Tooth Disease* ; Fentanyl ; Fractures, Compression ; Humans ; Intubation, Intratracheal ; Malignant Hyperthermia ; Propofol* ; Spine

Sebaceous carcinoma is a malignant neoplasm frequently classified as periocular or extraocular. Extraocular sebaceous carcinoma is a relatively rare tumor commonly appearing in the head and neck region. Furthermore, extraocular sebaceous carcinoma limited to the epithelium, which is called ‘extraocular sebaceous carcinoma in situ’ is extremely rare with less than 10 cases reported in the literature. Herein, we present the case of a 93-year-old female who diagnosed as extraocular sebaceous carcinoma in situ occurring concurrently with actinic keratosis. In the present case, extraocular sebaceous carcinoma in situ as identified without any connection to an adnexal component but concurrent with actinic keratosis. This case is evidence that extraocular sebaceous carcinoma can arise from the epidermis and the tumor cells of intraepidermal squamous neoplasia can differentiate toward malignant sebocytes.

Sebaceous carcinoma is a malignant neoplasm frequently classified as periocular or extraocular. Extraocular sebaceous carcinoma is a relatively rare tumor commonly appearing in the head and neck region. Furthermore, extraocular sebaceous carcinoma limited to the epithelium, which is called ‘extraocular sebaceous carcinoma in situ’ is extremely rare with less than 10 cases reported in the literature. Herein, we present the case of a 93-year-old female who diagnosed as extraocular sebaceous carcinoma in situ occurring concurrently with actinic keratosis. In the present case, extraocular sebaceous carcinoma in situ as identified without any connection to an adnexal component but concurrent with actinic keratosis. This case is evidence that extraocular sebaceous carcinoma can arise from the epidermis and the tumor cells of intraepidermal squamous neoplasia can differentiate toward malignant sebocytes.

PURPOSE: Recently, a nomogram predicting overall survival after gastric resection was developed and externally validated in Korea and Japan. However, this gastric cancer nomogram is derived from large-volume centers, and the applicability of the nomogram in smaller centers must be proven. The purpose of this study is to externally validate the gastric cancer nomogram using a dataset from a medium-volume center in Korea. MATERIALS AND METHODS: We retrospectively analyzed 610 patients who underwent radical gastrectomy for gastric cancer from August 1, 2005 to December 31, 2011. Age, sex, number of metastatic lymph nodes (LNs), number of examined LNs, depth of invasion, and location of the tumor were investigated as variables for validation of the nomogram. Both discrimination and calibration of the nomogram were evaluated. RESULTS: The discrimination was evaluated using Harrell's C-index. The Harrell's C-index was 0.83 and the discrimination of the gastric cancer nomogram was appropriate. Regarding calibration, the 95% confidence interval of predicted survival appeared to be on the ideal reference line except in the poorest survival group. However, we observed a tendency for actual survival to be constantly higher than predicted survival in this cohort. CONCLUSIONS: Although the discrimination power was good, actual survival was slightly higher than that predicted by the nomogram. This phenomenon might be explained by elongated life span in the recent patient cohort due to advances in adjuvant chemotherapy and improved nutritional status. Future gastric cancer nomograms should consider elongated life span with the passage of time.
Calibration ; Chemotherapy, Adjuvant ; Cohort Studies ; Dataset* ; Discrimination (Psychology) ; Gastrectomy ; Humans ; Japan ; Korea ; Lymph Nodes ; Nomograms* ; Nutritional Status ; Retrospective Studies ; Stomach Neoplasms*

Molecular mechanism of nuclear factor-kappaB(NF-kappaB) in the atherosclerosis has been unclear. Recently, NF-kappaB activating function of tissue transglutaminase (tTGase), multifunctional calcium-dependent transamidation enzyme, have been reported in the various tissues like neuroglia. In this report, we investigated the immunoreactivity of tTGase at the human atherosclerotic coronary artery, and examined the effect of tTGase on the well-known proatherogenic NF-kappaB pathway using tTGase-overexpressed cells. Immunohistochemical studies on autopsy samples showed that immunoreactivity of tTGase was markedly elevated in the neointimal tissues of atherosclerotic coronary arteries with progression of disease. Immunohistochemical staining also demonstrated that phosphorylated I-kappaB was activated in the atherosclerotic vessel wall. In vitro study using rat cardiomyoblast (H9c2) and tTGase-overexpressed H9c2 showed that activated tTGase enhanced the phosphorylation of I-kappaB, and this activation was inhibited by tTGase specific inhibitors. These findings suggest that cytosolic tTGase may serve as an activator of NF-kappaB.
Animals ; Atherosclerosis ; Autopsy ; Coronary Vessels* ; Cytosol ; Humans ; Neuroglia ; NF-kappa B* ; Phosphorylation ; Rats

Background: Proteomics and genomics studies have contributed to understanding the pathogenesis of chronic obstructive pulmonary disease (COPD), but previous studies have limitations. Here, using a machine learning (ML) algorithm, we attempted to identify pathways in cultured bronchial epithelial cells of COPD patients that were significantly affected when the cells were exposed to a cigarette smoke extract (CSE). Methods: Small airway epithelial cells were collected from patients with COPD and those without COPD who underwent bronchoscopy. After expansion through primary cell culture, the cells were treated with or without CSEs, and the proteomics of the cells were analyzed by mass spectrometry. ML-based feature selection was used to determine the most distinctive patterns in the proteomes of COPD and non-COPD cells after exposure to smoke extract.Publicly available single-cell RNA sequencing data from patients with COPD (GSE136831) were used to analyze and validate our findings. Results: Five patients with COPD and five without COPD were enrolled, and 7,953 proteins were detected. Ferroptosis was enriched in both COPD and non-COPD epithelial cells after their exposure to smoke extract. However, the ML-based analysis identified ferroptosis as the most dramatically different response between COPD and non-COPD epithelial cells, adjusted P value = 4.172 × 10−6 , showing that epithelial cells from COPD patients are particularly vulnerable to the effects of smoke. Single-cell RNA sequencing data showed that in cells from COPD patients, ferroptosis is enriched in basal, goblet, and club cells in COPD but not in other cell types. Conclusion Our ML-based feature selection from proteomic data reveals ferroptosis to be the most distinctive feature of cultured COPD epithelial cells compared to non-COPD epithelial cells upon exposure to smoke extract.