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With the surgical improvement of congenital heart disease, Fontan operation has been applied to many complicated patients in recent years. This is the first report of a child with panhypopituitarism who underwent Fontan operation. A 5-year-old boy was scheduled for Fontan operation. He previously underwent Blalock-Taussig shunt and bidirectional Glenn operations for univentricular heart with double-outlet right ventricle and pulmonary atresia. He was receiving hydrocortisone and 1-desamino-8-D-arginine vasopressin (DDAVP) for panhypopituitarism secondary to removal of craniopharyngioma performed at the age of three years. Although urine output and serum sodium concentration were adequately controlled by adjustment of vasopressin infusion rate during surgery, massive pleural effusions and ascites developed postoperatively, which required several days for control by adjusting the dose of oral DDAVP and normalize the serum sodium level. Intraoperative management of Fontan operation for a patient with panhypopituitarism was controllable by appropriate hormone replacement. However, postoperative fluid management was complicated by the clinical features of panhypopituitarism and Fontan physiology.

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We report a case of negative-pressure pulmonary edema occurring by tracheal obstruction caused by the brachiocephalic artery. The patient had deformed thorax with cerebral palsy, which deformed thorax placing the brachiocephalic artery high over the trachea, resulting in close and tight contact between the artery and trachea. Additional deformity of the thorax associated with myotonic attacks after general anesthesia might shorten the distance between the sternal notch and the vertebral body, resulting in the tracheal obstruction by the artery.

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We report a successful use of GlideScope AVL in a pediatric patient with Pierre Robin syndrome. A 36-day-old boy weighing 2.8 kg with Pierre Robin syndrome presented for tracheostomy after several weeks of trial airway management in prone position, who had failed to relieve his obstructive apnea. The Pentax-AWS videolaryngoscope equipped with the neonate Introck could not visualize his glottic opening. The GlideScope AVL single-use video laryngoscope equipping the #1 stat captured the view of the vocal cords. A tracheal tube (2.5 mm ID) with 90 degrees angled stylet, however, did not advance into the glottic opening, colliding with the anterior wall of the larynx and/or the laryngeal ventricle. Bending the tip of the stylet in a direction opposite to the inherent memory of the tube facilitated the placement of the tube into the trachea

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We report a successful use of pediatric Airtraq optical laryngoscope in a pediatric patient with Robin sequence. Robin sequence accompanies a characteristic facies and its clinical presentation is marked by micrognathia, retrognathia, glossoptosis, and respiratory obstruction. A 1-year-5 month-old boy with Robin sequence was scheduled for palate repair under general anesthesia. After anesthetic induction with thiopental and neuromuscular paralysis with rocuronium, initial laryngeal view with the conventional Macintosh laryngoscope was Cormack-Lehane grade II due to restricted mouth opening and micrognathia. The Airtraq Pedi provided the glottic view with Cormack-Lehane grade I and a preformed tracheal tube (ID 4 mm) was placed correctly into the trachea through the built-in tube channel. We conclude that the pediatric Airtraq has potential advantages over conventional direct laryngoscopy in children with difficult airway.

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A stable nanoemulsion consisting of nanometer-sized oil droplets in water having a self-standing capability was prepared by high-pressure emulsification. The nanoemulsion does not flow and has a yield stress. This nonfluidity is ascribed to the crystal-like lattice structure of nanodroplets. The lattice structure was observed by transmission electron microscopy of a freeze-fractured surface of the specimen. Small-angle neutron scattering (SANS) revealed the presence of an ordered structure in addition to spherical domains with a radius of 17 nm. This long-range order is, in principle, due to electrostatic repulsive interaction between charged nanodroplets. Dynamic light scattering (DLS) showed two relaxation modes, one for the collective motion of the lattice and the other for the translational diffusion of the nanodroplets. Dilution of the nanoemulsion resulted in a transition from a crystal-like structure to a typical colloidal solution.

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We describe the risk management of pediatric anesthesia. The most important risk management of pediatric anesthesia is airway and temperature management. Neonates and infants easily become hypoxic due to their insufficient functional residual capacity. Therefore airway management is most important not only during induction of anesthesia but also during maintenance of anesthesia and extubation. The management of patients' temperature, including control of room temperature should be taken into consideration. In addition, careful attention should be paid not to introduce air bubbles in any lines, especially in patients with congenital heart diseases.

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The microscopic structure of shear-induced gels for a mixed solution of 2-hydroxyethyl cellulose and nanometer-size spherical droplets has been investigated by in situ small-angle neutron scattering (SANS) with a Couette geometry as a function of shear rate gamma. With increasing gamma, the viscosity increased rapidly at gamma approximately 4.0 s(-1), followed by a shear thinning. After cessation of shear, the system exhibited an extraordinarily large steady viscosity. This phenomenon was observed as a shear-induced sol-gel transition. Real-time SANS measurements showed an increase in the scattering intensity exclusively at low scattering angle region. However, neither orientation of polymer chains nor droplet deformation was detected and the SANS patterns remained isotropic irrespective of gamma. It took about a few days for the gel to recover its original sol state. A possible mechanism of gelation is proposed from the viewpoint of shear-induced percolation transition.

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Based on colonoscopy findings, we made a preoperative diagnosis of primary mucinous cystadenocarcinoma of the appendix with features of a submucosal tumor (SMT) in the ascending colon. A 59-year-old woman who presented with right lower quadrant abdominal pain underwent colonoscopy, which revealed an SMT with three nodules covered with mucus in the ascending colon. Examination of colonoscopic biopsy specimens indicated "very" well-differentiated adenocarcinoma with mucus lakes. Abdominal computed tomography showed irregular wall thickness from the cecum to the ascending colon. The adjacent appendix had an enhanced wall and unclear border against the ascending colon. Thus, we performed right hemicolectomy, with good results. Histopathological examination revealed mucinous cystadenocarcinoma of the appendix, invading the ascending colon with fistula formation. Appendiceal tumors can manifest with a variety of colonoscopic features, and curative surgical resection should be attempted even if there is fistula formation.

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