脳死からの臓器摘出術における呼吸循環管理

今回われわれは，本邦で327例目，獨協医科大学越谷病院にて2例目となる脳死下臓器摘出術の呼吸循環管理を経験した．ドナーは30歳代男性で，くも膜下出血による脳死であった．獨協医科大学での最初の脳死下臓器摘出術は約7年前であり，この数年で管理方法が変化してきた．臓器摘出術における麻酔科の役割は麻酔ではなくドナーの呼吸循環管理であり，これにより摘出臓器の機能が大きく左右される．本症例での経験は，今後の本学における脳死下臓器摘出術に有用であると考えられる

Airway Obstruction due to Hematoma Following Internal Jugular vein Cannulation

A patient developed neck swelling and acute airway obstruction following an internal jugular vein cannulation. During laryngoscopy, glottic exposure was impossible because of a hematoma-induced anatomical distortion of standard laryngeal landmarks. Finally, a nasotracheal tube was intubated into the trachea fibreoptically. This life-threatening complication is rare, possible origin and mechanism for the sudden hematoma are discussed, as well as the airway management

ドッキョウ イカ ダイガク デ ハジメテ ノ ノウシ カラノ ゾウキ テキシュツ ジュツ ノ マスイ ケイケン

獨協医科大学で初めての脳死下臓器摘出術の麻酔を経験した.ドナーは50歳代の女性で,くも膜下出血による脳死であり,麻酔および摘出術は特に問題なく終了した.臓器摘出術の麻酔管理の主な要点は,各摘出臓器の機能を最大限に維持するための適切な循環および呼吸管理である.本症例におけるわれわれの経験は近い将来,獨協医科大学で行われるであろう臓器摘出術及び移植術の麻酔管理に有益な情報になると考えられた.We report the anesthetic management of the first case ofthe brain death for organ donation in Dokkyo Medical University.The donor was brain death after subarachnoidhemorrhage. Anesthesia and surgical procedure were doneuneventfully. The aims of anesthetic management are tomaintain optimal organ perfusion. We believe that this firstexperience will be helpful for the anesthetic management ofthe organ transplantation patient in the future of DokkyoMedical University

Metabolic products of Aspergillus terreus. V. Demethylation of asterriquinones.

Demethylation of asterriquinones (AQ, bisindolyl-dimethoxyl benzoquinones) was investigated in connection with the determination of their structures and studies of their antitumor activity. Usually, the demethylation proceeded smoothly with KOH, but several types of side reactions were observed with acidic reagents

A fragmented segment of a central venous catheter caused delayed ventricular fibrillation: a case report

Abstract Background Central venous port systems may be safely used for chemotherapy of patients with cancer, but several complications may occur associated with their use. Case presentation An 83-year-old man with heat stroke was transferred to our emergency department, where he was treated and became able to eat on the same day. He had been fit and healthy, except for colorectomy and chemotherapy using a central venous access port placed in the right upper jugular vein 8 years ago. The next day, he suddenly had ventricular fibrillation. Cardiopulmonary resuscitation was successful. Emergency coronary angiography showed a catheter-like foreign body in the coronary sinus. Physicians failed to remove the foreign body using catheter therapy, and ventricular fibrillation occurred repeatedly. After induction of general anesthesia, the fractured catheter was removed surgically. Postoperative course was uneventful. Conclusions A fragmented segment of a catheter may suddenly cause ventricular fibrillation years later

Acute-Stage Mental Health Symptoms by Natural Disaster Type: Consultations of Disaster Psychiatric Assistance Teams (DPATs) in Japan

This study analyzed the support activities that the Disaster Psychiatric Assistance Team (DPAT) in Japan provided following four previous disasters (a volcanic eruption, a mudslide, a flood, and an earthquake) to identify links between the disaster type and the characteristics of acute stage mental disorders observed. Using Disaster Mental Health Information Support System database records of consultations with patients supported by the DPAT during the survey period from 2013 (when DPAT was launched) to 2016, we performed cross-tabulations and investigated significant differences using chi-squared tests. For expected values less than 5, Fisher’s exact test was performed. Frequently occurring acute-stage symptoms after a disaster include anxiety, sleep problems, mood and affect, and physical symptoms. The affected population characteristics, victim attributes, severity of damage sustained, and evacuation status were the chief factors that influenced acute-stage mental health symptoms. The psychiatric symptoms detected in our study together with the results of diagnoses are important for determining the types of early interventions needed during the acute stage of a disaster. By sharing baseline mental health information, together with disaster-related characteristics highlighted in this study, mental health providers are better able to predict future possible mental disorders and symptoms