A 66-year-old man with thrombocytosis was brought to our hospital to undergo removal of a left ventricular thrombus. He had developed cerebral infarction 6 days before presenting to the hospital and suffered from right incomplete hemiparalysis. Blood tests on admission revealed his platelet count to be 124.3 × 104/μl. The urgent removal operation was performed under general anesthesia. For carrying out extracorporeal circulation (ECC), approximately three times as much heparin as expected was needed, as well as antithrombin III (AT III) administration. This met the definition of heparin resistance. The thrombus was removed and surgical left ventricular reconstruction was performed. Aspirin and warfarin were initiated on postoperative day 5. A bone marrow biopsy was performed on postoperative day 8, which revealed hypercellular marrow with megakaryocyte proliferation, and the patient was diagnosed as having essential thrombocythemia (ET). Although hydroxycarbamide administration started on postoperative day 10, his platelet count increased to 290.7 × 104/μl on postoperative day 13. The counts descended gradually, and on postoperative day 34, his platelet count reached the normal range and he was discharged from the hospital. In the perioperative period, his new neurologic abnormality did not appear. Addition of heparin, administration of AT III, and coating the cardiopulmonary bypass circuit with heparin or macromolecular polymer prevented clot formation and enabled safe ECC in a patient with ET and a high platelet count.

No abstract

A 32-year-old gravida 2, para 1 woman without structural cardiac disease was scheduled for her second cesarean section under combined spinal and epidural anesthesia (CSEA). She had stable hemodynamics after delivery; however, 16 min after the application of uterotonics, ventricular tachycardia (VT) with a heart rate (HR) of 150 bpm appeared. VT lasted for <30 s, and her hemodynamics remained stable. Ventricular arrhythmia frequently appeared for 3 min, and the HR at sinus rhythm was approximately 90 bpm. After the discontinuation of oxytocin, VT did not reappear. A postoperative 12-lead electrocardiogram showed first-degree atrioventricular block, but echocardiography performed 2 days later did not reveal any structural abnormalities. Autonomic nervous imbalance induced by CSEA, ephedrine, and oxytocin, as well as ergometrine may cause intraoperative VT during cesarean section in patients without structural cardiac disease.

The productions of calcium hydroxyapatite (Hap) and Ti(IV)-doped Hap (TiHap) particles were examined by forced hydrolysis reaction of Ca(OH) 2 -pyrophosphate (pp: P 2 O 7 4¹) and Ca(OH) 2 -pp-TiCl 4 mixed solutions under 100 and 140°C, respectively, and precipitated particles were characterized by various physicochemical techniques. The degree of hydrolysis of pp ions was remarkably improved and the yields of the precipitates by using the pp ions was increased rather than the tpp one. No particles were produced at higher concentration of pp ions. On the other hand, ellipsoidal aggregated and rod-like particles were produced at other concentration domains. The Hap particles produced were ellipsoidal secondary particles with ca. 210240 nm in the particle length which were composed by aggregation of small primary single crystal particles with ca. 2050 nm in length. The TiHap particles facilitated at atomic ratio of Ti/(Ca+Ti) [X Ti ] ¼ 0.20 were ellipsoidal secondary particles with ca. 240380 nm in length composing by aggregation of small primary particles with ca. 30100 nm in length, while they were changed to very fine particles with ca. 510 nm in diameter along with small amounts of large rod-like particles at X Ti = 0.3. The highly crystallized pure TiHap particles were produced at X Ti ¼ 0.15, while the Hap structure was almost disappear at X Ti = 0.2. All the TiHap particles produced at X Ti¯0 .2 were phosphorus deficient. The diffuse reflectance UV spectra of TiHap particles revealed that these particles have a UV absorption property, especially fabricated at X Ti = 0.05. The highly crystallized TiHap particles (0.05 ¼ X Ti ¼ 0.15) had also large specific surface area.

Accelerated idioventricular rhythm (AIVR) during anesthesia has been described in several drug toxicity such as from cocaine, halothane, desflurane, and propofol. We present the case of a man who developed episodes of AIVR observed under total intravenous anesthesia (TIVA) using remifentanil, propofol, and rocuronium. AIVR during anesthesia was a benign phenomenon, and further examinations after surgery showed no structural heart disease and the daily occurrence of idioventricular arrhythmias. This case suggests that the suppression of sinus and atrioventricular nodal function and the autonomic imbalance caused by propofol and remifentanil may induce AIVR with greater frequency.