Pancuronium bromideにて高血圧および頻脈発作をきたした無症候性褐色細胞腫の1例

麻酔導入時のpancuroniumbromideの投与により著明な高血圧および頻脈をきたした興味ある無症候性褐色細胞腫の1例を報告する.症例は33歳男子で, 主訴は左副腎腫瘍の精査, 家族歴および既往歴に特記すべきことなし, 右季肋下部不快感で某医でCTスキャンを受けたところ, 左副腎腫瘍を指摘された.諸検査成績で尿中カテコラミンが軽度に上昇する以外に異常はない.7月1日手術目的で入院し, 同19日左副腎摘除術を受けた.エトレンおよび笑気で十分な全身麻酔をおこなった後, pancuronium7.5mgを筋弛緩を得るため投与したところ急激な血圧上昇(220mmHg), 2段脈, 心室性頻脈を認めた.Lidocain(R), Inderal(R), Regitine(のR)投与にて症状は消失した.手術中に特記すべき血圧の変動は認められなかった.腫瘍の重さは33.69で, 組織所見は褐色細胞腫であった.福色細胞腫における高血圧の発症機序についてはいまだ不明な点が多い.交感神経刺激作用を有するとされるpanecuroniumbromideにより高血圧症をきたしたことは本症の高血圧発症を考える上で興味深く, 若干の文献的考察を加えた.We present a case of asymptomatic pheochromocytoma with severe hypertension and tachycardia evoked by the administration of pancuronium bromide, a nondepolarizing muscle relaxant which has been used commonly in the anesthetic management of patients with pheochromocytoma

A case of idiopathic omental hemorrhage

With the exception of trauma, intraperitoneal hemorrhage in young women is caused by the high frequency of ectopic pregnancy and ovarian bleeding. Here, we describe a case of idiopathic omental hemorrhage, which is a rare cause of intraperitoneal hemorrhage. Intraperitoneal hemorrhage was suspected in a 38-year-old Japanese woman based on contrast-enhanced computed tomography. Her last menstrual period was 23 days prior, and ovarian bleeding was considered based on bloody ascites revealed by culdocentesis. She underwent emergency surgery for hypovolemic shock. Although both ovaries were of normal size and no abnormal findings were observed, we performed a partial omentectomy because multiple clots were attached only to the greater omentum. Postoperatively, no rebleeding occurred, and she was discharged 11 days after the surgery. Because she did not have a clear history of trauma and underlying disease, idiopathic omental hemorrhage was diagnosed

The Outcome of Repeated In Vitro Fertilization-Embryo Transfer Based on the Endometrial Thickness

Objective: To determine whether in vitro fertilization embryo transfer (IVF-ET) outcome is affect- ed by endometrial thickness. Design: Retrospective study. Setting: IVF-ET unit in Osaka Medical College. Patients: Twenty-eight patients with tubal infertility who became pregnant following IVF-ET between 1998-2000. All patients underwent 2 cycles of IVF-ET with long down-regulation protocol of Gonadotorophin releasing hormone analogue (GnRHa) and became pregnant following one of them. These fifty-six courses were divided into pregnant and non-pregnant courses. Main Outcome Measure(s): Endometrial thickness, serum E2 and LH levels, number of oocytes, fertilization rate, cleavage rate, high quality embryo rate and pregnancy rate were investigated. Results: The endometrium in the pregnant courses were thicker than those in the non-pregnant courses (P<0.05). Serum E2 level showed direct correlation with endometrial thickness (R=0.882, P < 0.001). The courses with endometrial thickness greater than or equal to 10 mm showed a signifi- cantly higher pregnancy rate than courses with endometrium of less than 10 mm. Although there was no statistical difference in high-quality embryo rate or number of transferred embryo rate between the two groups, the fertilization rate of the courses with endometrium greater than or equal to 10 mm was higher than that in the courses with endometrium less than 10 mm. Conclusion: Although the number of transferred embryos and embryo quality does not affect the pregnancy rate, endometrial thickness might play an important role in the success of IVF-ET