Prolapse of the Small Intestine from the Uterine Perforation at Dilatation and Curettage

Dilatation and curettage (D&C) sometimes causes uterine perforation, which usually does not cause a serious problem. Here, we report uterine perforation caused by D&C, in which the small intestine prolapsed from the uterus, requiring intestinal resection. D&C was performed for missed abortion at 9 weeks. After dilating the cervix, forceps grasped tissue that, upon being pulled, resulted in the intestine being prolapsed into the vagina. Laparotomy revealed a perforation at the low anterior uterine wall, through which the ileum had prolapsed. The mesentery of the prolapsed ileum was completely detached and the ileum was necrotic, which was resected. The uterus and the intestine were reconstructed. Although intestinal prolapse is considered to be caused by “unsafe” D&C performed by inexperienced persons or even by nonphysicians in developing countries, this occurred in a tertiary center of a developed country. We must be aware that adverse events such as uterine perforation with intestinal prolapse can occur even during routine D&C

Hippocampal Remapping after Partial Inactivation of the Medial Entorhinal Cortex

Hippocampal place cells undergo remapping when the environment is changed. The mechanism of hippocampal remapping remains elusive but spatially modulated cells in the medial entorhinal cortex (MEC) have been identified as a possible contributor. Using pharmacogenetic and optogenetic approaches, we tested the role of MEC cells by examining in mice whether partial inactivation in MEC shifts hippocampal activity to a different subset of place cells with different receptive fields. The pharmacologically selective designer Gi-protein-coupled muscarinic receptor hM4D or the light-responsive microbial proton pump archaerhodopsin (ArchT) was expressed in MEC, and place cells were recorded after application of the inert ligand clozapine-N-oxide (CNO) or light at appropriate wavelengths. CNO or light caused partial inactivation of the MEC. The inactivation was followed by substantial remapping in the hippocampus, without disruption of the spatial firing properties of individual neurons. The results point to MEC input as an element of the mechanism for remapping in place cells

Case Report Successful Treatment with Biperiden for Extrapyramidal Reactions from Droperidol

Abstract Although extrapyramidal reactions have been reported as a side e#ect from droperidol, information to management for this side e#ect is not well known. We report herein 2 cases of extrapyramidal reactions associated with droperidol administration in the postoperative period. In Case 1: 27-year-old man underwent orthopedic surgery under spinal anesthesia. After the surgery, acute dystonia developed after droperidol administration for intraoperative sedation. 5 mg of biperiden resolved these extrapyramidal signs completely. In Case 2: 11-year-old girl underwent laparotomy under combined epidural and general anesthesia. Oculogyric crisis occurred after starting continuous epidural infusion of droperidol to treat postoperative nausea and vomiting. 3mg of biperiden diminished these reactions completely. Extrapyramidal reactions such as acute dystonia and oculogyric crisis are occasionally treated as transient postoperative psychic symptoms, since such reactions are not commonly known among medical sta# in the perioperative period. Anesthesiologists should be aware of the risk of developing extrapyramidal symptoms to droperidol. In addition, biperiden can be successfully used as treatment