A Case Report of Peutz-Jeghers Syndrome with a Giant Colon Polyp
Makoto YoshidaTeruhiko SakamotoI KobayashiHiroshi IshiharaHiroshi OkanoTetsuya SaruyaShinya SaruyaSHINICHI SAITOUKouta KobayashiYuuji WashidaKeigo IesakiS. OkamuraToshikazu SekiguchiMasatomo MoriSusumu OowadaKatsue Yoshida
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Abstract:
Peutz-Jeghers症候群は消化管ポリポーシスの概念に入る疾患で，消化管での多発ポリープを認めるが，今回われわれは結腸に大きさ4×5cmの巨大ポリープを伴う症例を経験したので報告する。症例は16歳女性。家族歴に特記すべきことなし。平成2年12月，口唇および四肢末端に黒褐色の色素沈着を指摘され皮膚科を受診した。Peutz-Jeghers症候群を疑われ，当科を受診し，胃および大腸内視鏡検査，小腸造影検査にて多発ポリープを認め，大腸ポリペクトミー目的にて当科入院となった。入院後，大腸内視鏡にて，上行結腸の大きさ4×5cmの巨大ポリープに対する内視鏡治療は困難と考え，当院外科にて結腸部分切除，空腸部分切除および術中空腸ポリペクトミーを施行した。また，当科再入院にて胃ポリペクトミーを施行した。本例はPeutz-Jeghers症候群に伴う消化管ポリープに対する内視鏡治療の可能性と限界を示す症例と考えられた。Keywords:
Peutz–Jeghers syndrome
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Seperti pada dewasa, teknik regional anestesi pada pediatrik kini makin popular digunakan oleh ahli anestesikarena keuntungannya. Namun demikian selalu ada risiko dan kemungkinan timbulnya komplikasi dari setiap tindakan yang dilakukan, termasuk tindakan anestesi regional pada pediatrik. Insidensi komplikasi anestesi regional pada pediatrik tidak banyak, dan kalaupun terjadi komplikasi adalah minor. Komplikasi bisa diakibatkan dari identifikasi ruang saraf, alat, obat, teknis tindakan anestesi regionalnya dan komplikasi lainnya.Walaupun tidak banyak kejadian komplikasi regional anestesi yang dilaporkan pada pediatrik, dan bukanlah komplikasi yang fatal, teknik regional anestesi pada pediatrik harus dilakukan dengan lebih hatihati, pertimbangan risiko dan keuntungannya untuk menghindari terjadinya komplikasi, terlebih karena kebanyakan komplikasi dapat dihindari dengan mempelajari teknik yang benar, menggunakan peralatan yang sesuai, dan sangat menerapkan prinsip keamanan pada pasien dengan baik.
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Genentech is partnering with the German cancer company Affimed to develop immunotherapies for multiple kinds of solid and blood cancers. Affimed is developing therapies that engage natural killer cells of the innate immune system to help direct them to attack cancer cells. Genentech will pay Affimed $96 million up front and up to $5 billion more in potential payments.
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ABSTRACT Airway management is particularly difficult in children with severe congenital anomalies. Such patients are extre- mely sensitive to the respiratory depressant effects of anaesthetic agents. We describe the successful and safe app- lication of caudal anaesthesia for inguinal hernia repair in three cases with severe congenital anomalies (Joubert syndrome, I-cell syndrome). The three patients concerned had congenital anomalies including serious facial defor- mity, respiratory failure and cardiovascular defects. They were administered a single dose of caudal epidural anaest- hesia for inguinal hernia surgery in order to avoid complications associated with general anaesthesia. Caudal block was performed and 1 mL/kg levobupivacaine 0.25% administered. We conclude that caudal epidural anaesthesia can be an effective, suitable and safe anaesthetic technique for inguinal herniotomy without the need for general anaesthesia or endotracheal intubation in children with severe congenital anomalies. Key Words: Caudal anaesthesia, children, congenital anomaly OZET Havayolu yonetimi, ciddi konjenital anomalileri olan cocuklarda ozellikle zordur. Bu tur hastalar anestezik ilaclarin solunum depresan etkilerine karsi asiri derecede duyarlidir. Kaudal anestezinin inguinal herni onarimindaki basarili ve guvenli uygulamasi konjenital anomalileri (Joubert sendromu, I-cell hastaligi) olan uc olguda gosterilmistir. Ilgili uc cocuk hastada, ciddi yuz deformitesi, solunum yetmezligi ve kardiyovaskuler bozukluk dahil konjenital bozuk- luklar vardi. Genel anesteziyle iliskili komplikasyonlari onlemek icin inguinal herni cerrahisinde tek doz kaudal epi- dural anestezi uygulandi. Kaudal anestezide %0.25 levobupivakain 1 mL/kg kullanildi. Kaudal epidural anestezinin, ciddi konjenital bozukluklari olan cocuklarda inguinal herni onarimi acisindan genel anesteziye veya endotrakeal entubasyona gerek duyulmadan etkili, uygun ve guvenli bir alternatif anestezi teknigi olabilecegi sonucuna varildi. A na h ta r Sozcukler: Kaudal anestezi, cocuk, konjenital bozukluk
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