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The incidence of a tracheal bronchus supplying the right upper lobe has been reported to be in the range of 0.1 to 3%. We encountered 3 cases with the anomaly among 200 cases of lung surgery conducted over a year at our hospital. In the first case, we had difficulty in intubating the patient with a double-lumen tube. In the other two cases, the tracheal bronchus was detected by fiberoptic bronchoscopy during the lung surgery. Patients with a tracheal bronchus may be difficult or impossible to ventilate, especially when requiring unilateral lung ventilation. Therefore, the airway must be assessed carefully by fiberoptic bronchoscopy prior to unilateral lung surgery, keeping in mind the possibility of a tracheal bronchus, in order to design a safe way to secure it safely during the surgery.

The purpose of this study was to evaluate the effectiveness and adverse events of combination chemotherapy with S-1 and docetaxel (DOC) as neo-adjuvant chemotherapy (NAC) for patients with oral squamous cell carcinomas. Fifteen patients were enrolled in this study (11 men and 4 women, with a mean age of 65.9 years). All patients given S-1 80 mg/body per day for 14 days and following were administered a dose of DOC 60 mg/m(2) by drip infusion for 120 minutes. The locoregional response was evaluated 3 weeks after the administration. As a result, the locoregional response rate was 60.0%, including 46.7% complete response. According to Oboshi and Shimosato's classification, histological evaluation of surgical specimens revealed that 3 cases were Grade I , 3 cases Grade IIa, 4 cases Grade IIb, 1 case Grade III, 3 cases Grade IVb, and 1 case Grade IVc. The severe side effect was neutropenia. The present study suggests that combination chemotherapy with S-1 and DOC is an effective and safe regimen in NAC for oral squamous cell carcinomas.

We evaluated the effect of stellate ganglion block (SGB) on the blood flow of celiac artery (CA) and superior mesenteric artery (SMA) by using the ultrasonic pulse Doppler technique. The subjects were 15 healthy volunteers (14 males, one female; average 26 years old; 22-38). Right C7-SGB was performed using 5 ml of 1% mepivacaine at the 7th cervical process. Blood pressure, heart rate, mean blood flow velocity and diameter in CA and SMA, were measured after 5 minute rest, before and after SGB. To measure the flow velocity and the diameter of vessels, ultrasonic diagnostic equipment SSA-270A or SSA-260A (Thoshiba CO, Ltd.) with convex electric-phased 3.75 MHz, probe was used. Doppler shiftgrams of the CA and SMA were recorded. Then, we calculated their flow volume and sectional area of vessels. In CA mean blood flow velocity tended to decrease (P < 0.05) and both flow volume and sectional area of vessels tended to increase (P < 0.001). In SMA, mean flow velocity tended to decrease (P < 0.05) and sectional area increased (P < 0.001). But flow volume did not show significant change. Our results indicate that right C7-SGB leads to an increase in the blood flow of CA.

Four patients with severe and intractable cancer pain were treated with continuous subarachnoid analgesia (CSA). All patients underwent placement of a 32-gauge subarachnoid catheter attached to an infusion pump allowing continuous administration of local anesthetic agent and morphine. CSA produced good pain relief except in one patient. There was no severe complication, but itching developed in one patient. At present, CSA is not a routine treatment, because it may lead to severe complications. CSA produces excellent pain relief without disturbing consciousness and is recommended for the treatment of severe and intractable cancer pain.