Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：JA Clinical Reports  

Background: Anesthetic management of pheochromocytoma and paraganglioma with Fontan circulation is challenging for physicians, with attention to cardiovascular physiology. Case presentation: We performed anesthetic management for pheochromocytoma and paraganglioma in three patients with Fontan circulation. We maintained intraoperative central venous pressure at preoperative level under fluid infusion and administrating nitric oxide to decrease pulmonary arterial resistance. We administered noradrenaline or vasopressin if low blood pressure was present despite adequate central venous pressure. Although noradrenaline is prevalent for the case of noradrenaline-secreting tumor especially after resection, we could maintain blood pressure to administrate vasopressin without increasing central venous pressure. Retroperitoneal laparoscopic approach which could avoid intra-abdominal adhesions might be selectable as case 3. Conclusions: Sophisticated management is required for pheochromocytoma and paraganglioma with Fontan circulation.

DOI： 10.1186/s40981-023-00605-z

Scopus

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

Language：English   Publisher：American Journal of Emergency Medicine  

Patients with infectious diseases including sepsis can develop ST segment changes on an electrocardiogram (ECG) in the absence of coronary artery disease. However, ST elevation with “reciprocal ST segment depression (RSTD)”, which is recognized as a specific finding for ST-elevated myocardial infarction, is rare in such patients. Although a small number of cases have reported ST-segment elevation in gastritis, cholecystitis, and sepsis, regardless of coronary artery disease, none presented with reciprocal changes. Here, we describe a rare case of a patient with emphysematous pyelonephritis complicating septic shock who developed ST elevation accompanied by reciprocal changes with no coronary occlusion. Emergency physicians should consider the possibility of acute coronary syndrome mimicking, and choose non-invasive diagnostic procedures when investigating the causes of ECG abnormalities associated with critically ill patients.

DOI： 10.1016/j.ajem.2023.06.038

Web of Science

Scopus

PubMed

Language：English   Publisher：Springer Berlin Heidelberg  

褐色細胞腫とパラガングリオーマに対し麻酔管理を行ったフォンタン循環患者3症例を報告した。症例1は30歳男性、症例2は35歳男性、症例3は35歳女性で、症例1と症例2は褐色細胞腫に対する右副腎摘除歴があった。パラガングリオーマの局所再発と診断され、開腹腫瘍切除を行った。症例3はパラガングリオーマに対する開腹腫瘍切除歴があった。上下大静脈肺動脈吻合転換術の術前検査で褐色細胞腫・パラガングリオーマの局所再発が偶然発見され、経後腹膜的腹腔鏡下腫瘍切除を行った。いずれの症例でも、輸液投与により術中の中心静脈圧を術前レベルに維持し、一酸化窒素の投与により肺動脈抵抗を低下させた。血圧低下の場合はノルアドレナリンやバソプレシンを投与した。いずれの症例でも予定通り手術を施行できた。

Event date： 2024.4

Language：Japanese  

Venue：北九州   Country：Japan  

Event date： 2024.4

Language：Japanese  

Venue：仙台   Country：Japan  

Language：Japanese  

Language：Japanese