Left-sided gallbladder (LSGB) is a rare anomaly, but it is often associated with multiple combined variations of the liver anatomy. We present the case of a patient with LSGB who underwent successful resection of perihilar cholangiocarcinoma. The patient was a 67-year-old male who presented with upper abdominal pain and obstructive jaundice. Initial imaging studies led to the diagnosis of Bismuth-Corlette type IIIB perihilar cholangiocarcinoma. Due to the unique location of the gallbladder and combined multiple hepatic anomalies, LSGB was highly suspected. During surgery after hilar dissection, we recognized that the tumor was located at the imaginary hilar bile duct bifurcation, but its actual location was corresponding to the biliary confluence of the left median and lateral sections. The extent of resection included extended left lateral sectionectomy, caudate lobe resection, and bile duct resection. Since some of the umbilical portion of the portal vein was invaded, it was resected and repaired with a portal vein branch patch. Due to anatomical variation of the biliary system, only one right-sided duct was reconstructed. The patient recovered uneventfully without any complication. LSGB should be recognized as a constellation of multiple hepatic anomalies, and therefore, thorough investigations are necessary to enable the performance of safe hepatic and biliary resections.
Abdominal Pain ; Aged ; Bile Ducts* ; Biliary Tract ; Cholangiocarcinoma* ; Diagnosis ; Gallbladder* ; Hepatectomy* ; Humans ; Jaundice, Obstructive ; Liver ; Male ; Portal Vein

BACKGROUND: Palonosetron is a recently introduced 5-hydroxytryptamine-3 (5-HT3) receptor antagonist useful for postoperative nausea and vomiting prophylaxis. However, 5-HT3 receptor antagonists increase the corrected QT (QTc) interval in patients who undergo general anesthesia. This retrospective study was performed to evaluate whether palonosetron would induce a QTc prolongation in patients undergoing general anesthesia with sevoflurane. METHODS: We reviewed a database of 81 patients who underwent general anesthesia with sevoflurane. We divided the records into palonosetron (n = 41) and control (n = 40) groups according to the use of intraoperative palonosetron, and analyzed the electrocardiographic data before anesthesia and 30, 60, 90, and 120 min after skin incision. Changes in the QTc interval from baseline, mean blood pressure, heart rate, body temperature, and sevoflurane concentrations at each time point were compared between the two groups. RESULTS: The QTc intervals at skin incision, and 30, 60, 90, and 120 min after the skin incision during general anesthesia were significantly longer than those at baseline in the two groups (P < 0.001). The changes in the QTc intervals were not different between the two groups (P = 0.41). However, six patients in the palonosetron group showed a QTc interval > 500 ms 30 min after skin incision, whereas no patient did in the control group (P = 0.01). No significant differences were observed between the two groups in mean blood pressure, body temperature, heart rate, or sevoflurane concentrations. CONCLUSIONS: Palonosetron may induce QTc prolongation during the early general anesthesia period with sevoflurane.
Anesthesia ; Anesthesia, General* ; Arrhythmias, Cardiac ; Blood Pressure ; Body Temperature ; Electrocardiography ; Heart Rate ; Humans ; Incidence* ; Isoquinolines ; Laparotomy* ; Methyl Ethers ; Patient Safety ; Postoperative Nausea and Vomiting ; Quinuclidines ; Receptors, Serotonin, 5-HT3 ; Retrospective Studies ; Skin

BACKGROUND: Many studies of the effect of catechins, a major substance in green tea, on sarcopenia have been conducted using animal models or as in vitro experiments, revealing that they increase muscle mass, inhibit proteases, and promote satellite cell proliferation. No study has been conducted targeting human subjects relative to the correlation between green tea and sarcopenia. The purpose of this study was to investigate the correlation between green tea intake and sarcopenia in menopausal women using the Korea National Health and Nutrition Examination Survey (2008–2011).METHODS: This study included 3,473 menopausal women after excluding those diagnosed with gastric cancer and other cancers. The frequency of green tea intake was determined based on the Food Frequency Questionnaire, and the value acquired from calibrating the extremity muscle mass measured using dual-energy X-ray absorptiometry with weight was used as the muscle mass. Sarcopenia was defined using values less than two standard deviations as cut-offs after determining the mean and standard deviation of the muscle mass in the group of young and healthy women.RESULTS: In menopausal women, the odds ratio of the group drinking a cup or less and two or more cups of green tea to that of the group not drinking green tea was 1.170 (0.891–1.536), and the 95% confidence interval was 1.530 (0.744–3.146). A significant linear trend was not observed in the result (P for trend 0.148).CONCLUSION: There was no significant correlation between green tea intake and sarcopenia in menopausal women in Korea.
Absorptiometry, Photon ; Catechin ; Cell Proliferation ; Cross-Sectional Studies ; Drinking ; Extremities ; Female ; Humans ; In Vitro Techniques ; Korea ; Models, Animal ; Nutrition Surveys ; Odds Ratio ; Peptide Hydrolases ; Sarcopenia ; Stomach Neoplasms ; Tea

Anesthetic management of pediatric liver transplantation in a patient with osteogenesis imperfecta (OI) requires tough decisions and comprehensive considerations of the cascade of effects that may arise and the required monitoring. Total intravenous anesthesia (TIVA) with propofol and remifentanil was chosen as the main anesthetic strategy. Malignant hyperthermia (MH), skeletal fragility, anhepatic phase during liver transplantation, uncertainties of TIVA in children, and propofol infusion syndrome were considered and monitored. There were no adverse events during the operation. Despite meticulous precautions with regard to the risk of MH, there was an episode of high fever (40degrees C) in the ICU a few hours after the operation, which was initially feared as MH. Fortunately, MH was ruled out as the fever subsided soon after hydration and antipyretics were given. Although the delivery of supportive care and the administration of dantrolene are the core principles in the management of MH, perioperative fever does not always mean a MH in patients at risk for MH, and other common causes of fever should also be considered.
Anesthesia, Intravenous ; Antipyretics ; Child ; Dantrolene ; Fever ; Humans ; Infant* ; Liver Transplantation* ; Malignant Hyperthermia ; Osteogenesis Imperfecta* ; Pediatrics ; Pharmacokinetics ; Propofol