Primary aldosteronism (PA) causes biochemical abnormalities such as hypokalemia and metabolic alkalosis. This study aimed to compare the effects of aldosterone on serum potassium and corrected bicarbonate (cHCO(3)(-), defined as Na - Cl - 12) between PA and non-PA and between unilateral and bilateral PA (uPA and bPA, respectively). A total of 463 patients from the Japan Primary Aldosteronism Study II, who had been enrolled as of January 2024, were analyzed. Correlations between plasma aldosterone concentration (PAC) and serum potassium, as well as cHCO(3)(-), were evaluated in PA vs. non-PA and in uPA vs. bPA. In the PA group, PAC was significantly correlated with both serum potassium (r = -0.449, P < 0.05) and cHCO(3)(-) (r = 0.439, P < 0.05), whereas no significant correlations were observed in the non-PA group. Among PA subtypes, uPA showed significant correlations between PAC and serum potassium (r = -0.299, P < 0.05) and cHCO(3)(-) (r = 0.420, P < 0.05). Conversely, in bPA, PAC showed a weaker correlation with serum potassium (r = -0.178, P < 0.05) and no significant correlation with cHCO(3)(-). Even in the analysis with matched PAC between uPA and bPA, a significant correlation between PAC and cHCO(3)(-) was observed only in uPA (r = 0.415, P < 0.05), whereas no such correlation was found in bPA, with a significant difference between the two groups (P < 0.05). uPA was observed in 96.7% of patients with PA who had PAC >= 150 pg/mL and cHCO(3)(-) >= 28 mmol/L. In conclusion, PAC is significantly correlated with cHCO(3)(-) in uPA, but not in non-PA or bPA. cHCO(3)(-) is potentially useful for evaluating disease activity in uPA and detecting uPA.
Innominate artery compression syndrome (IACS) is rare in adults and poses anesthetic challenges, as airway manipulation may exacerbate tracheal compression or compromise cerebral perfusion. Peri-intubation cerebral oxygenation in this context has rarely been reported. We describe the case of an 82-year-old woman with incidentally detected, asymptomatic IACS and moderate tracheal stenosis who underwent robot-assisted rectal surgery under general anesthesia. During fiberoptic-guided tracheal intubation, bilateral radial arterial pressures and near-infrared spectroscopy (NIRS) were continuously monitored to assess vascular and cerebral perfusion. No decline in regional cerebral oxygen saturation (rSO2) or increase in bilateral arterial pressure gradient was observed, and ventilation remained stable, including during steep Trendelenburg positioning. Careful anesthetic planning, with continuous monitoring of cerebral oxygenation and bilateral arterial pressures, may facilitate safe perioperative management in adults with this syndrome.
Objective Japanese phase 3 clazosentan trials excluded patients aged ≥ 76 years, WFNS grade V, and Fisher groups other than 3. Using RECOVER, we compared clazosentan with fasudil in these post-approval populations. Methods After excluding patients who received both agents, this prespecified subgroup analysis included 398 patients (clazosentan 161; fasudil 237). The primary endpoint was favorable discharge outcome (modified Rankin Scale 0–2). Subgroups were age ≥ 76 years, WFNS grade V, Fisher group 1, 2, or 4, and Fisher group 4. Adjusted logistic and interaction analyses were exploratory. Results The subgroup sizes were 75 patients aged ≥ 76 years, 71 with WFNS grade V, 173 with Fisher group 1, 2, or 4, and 96 with Fisher group 4, respectively. Estimated associations for favorable outcome favored clazosentan in patients aged ≥ 76 years (40.0% vs 24.0%; adjusted OR 3.52), those with WFNS grade V (21.7% vs 12.5%; adjusted OR 1.59), those with Fisher group 1, 2, or 4 (67.1% vs 43.7%; adjusted OR 3.17, 95% CI 1.31–8.12), and those with Fisher group 4 (45.5% vs 22.2%; adjusted OR 3.12). Vasospasm-related delayed cerebral ischemia was absent in the clazosentan group in both Fisher-defined subgroups. No consistent excess of major adverse events was identified. Conclusions Trial exclusion criteria did not identify subgroups with loss of favorable association or clear safety penalty. Age ≥ 76 years, WFNS grade V, or non-Fisher group 3 status reflect trial ineligibility rather than contraindication, and they should prompt individualized benefit-risk assessment rather than automatic avoidance.
Spontaneous rupture of the aorta is a rare, lethal condition that is hard to diagnose preoperatively. We report two cases of patients who presented with sudden-onset chest or pharyngeal pain. Contrast-enhanced computed tomography (CT) showed an ulcer-like projection, mediastinal hematoma, and pericardial effusion, but no definitive intimal flap. Emergency surgery was performed with a tentative diagnosis of thrombosed-type aortic dissection. In both cases, there was a localized aortic transmural laceration with a thrombus near the sino-tubular junction on the pulmonary artery side. Based on a focal intimal defect with no or minimal dissection in adjacent area, the diagnosis of spontaneous rupture of the aorta was made. Both patients were successfully treated with replacement of the ascending aorta and had favorable outcomes. When hemopericardium or mediastinal hematoma is present without clear evidence of aortic aneurysm or dissection, spontaneous rupture of the aorta must be considered, as prompt surgical intervention is crucial for survival.
Shared decision making in renal replacement therapy should reflect patient values. However, the quantitative impact of family involvement—particularly in Asian contexts—on decision-making quality remains underexplored. This nationwide, multicenter cross-sectional study (October 2022–February 2025) involved 475 adults with stage 5 chronic kidney disease across 49 facilities in Japan. Following the selection of renal replacement therapy, participants were surveyed regarding the final decision-makers and their specific roles. Shared decision-making quality was evaluated using the three-item CollaboRATE scale, assessing information exchange and preference integration. Compared with “physician-only” decisions, CollaboRATE scores (points; 95% confidence interval) were significantly higher in the “patient and physician” (+ 12.3; 1.5–23.2) and “patient, physician, and key person” groups (+ 13.7; 0.8–26.7). Role-based analyses showed that shared decision-making with the physician or key person was associated with a + 10.0 point increase (3.2–16.8) versus decisions without patient involvement. Among patients having family, scores were significantly higher for patient only (+ 9.5), patient-led with input from physician or key person (+ 10.4), and shared decision-making (+ 12.1) categories, compared with no patient involvement. Family involvement enhances shared decision-making quality when selecting renal replacement therapy, particularly when the process remains collaborative and guided by patient preferences.
