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

Non-tuberculosis Mycobacterium Tenosynovitis with Rice Bodies in a Patient with Systemic Lupus Erythematosus

Infectious disease with various presentations in systemic lupus erythematosus often resembles lupus flare. A 37-year-old woman presented with a swollen left index finger that had not resolved, despite 7 years of immunosuppressive treatment. MRI showed rice-body formation in the flexor tendon sheath and tenosynovectomy demonstrated chronic synovitis with epithelioid granuloma. A mycobacterial culture confirmed invasive mycobacterial tenosynovitis due to Mycobacterium chelonae. The patient was treated with moxifloxacin and clarithromycin and completely recovered

A case of variant angina treated with a pacemaker for cardiopulmonary arrest due to complete atrioventricular block and pulseless electrical activity

A 55-year-old woman with variant angina was hospitalized for cardiopulmonary arrest because of pulseless electrical activity (PEA). Despite intensive postresuscitation drug therapy, another episode of angina occurred, with complete atrioventricular block and PEA. There was no confirmed ventricular fibrillation or ventricular tachycardia. Coronary arteriography did not show significant stenosis, and acetylcholine-loading test was positive. The patient was diagnosed with coronary spastic angina, and a pacemaker was implanted to stabilize hemodynamics during attacks. The pacemaker settings required some ingenuity: a high output was selected to avert pacing failure, and a rate drop response setting was selected to ensure efficient pacing