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Biomedical subjects

A Matsuki

Publications and source records attributed to A Matsuki.

At least 199 records · Page 11Linked to original sources
PubMed1995

[Arterial plasma keton body levels during isoflurane anesthesia and surgery].

The authors measured arterial plasma levels of acetoacetate, 3-hydroxybutyrate, free fatty acid and the blood levels of lactate and glucose to evaluate fat metabolism during isoflurane anesthesia and surgery in twenty patients who ranged in age from 17 to 67 years. They underwent non-abdominal surgery (orthopedic surgery) or abdominal surgery (gastrointestinal or gynecological surgery). The operation started at 9 AM following starvation after 9 PM of the day before surgery. Anesthesia was induced with intravenous thiopental followed by intravenous succinylcholine to facilitate tracheal intubation, and maintained with isoflurane in 50 % nitrous oxide and 50 % oxygen. Vecuronium was given intravenously during surgery. Lactated Ringer's solution at a speed of 5-15 ml.kg-1.h-1 was also administered intravenously throughout the procedures. Patients who had received glucose solution or blood transfusion were excluded. Plasma acetoacetate and 3-hydroxybutyrate levels increased significantly with surgical stimulation in both groups and they were slightly higher in the abdominal group than those in the non-abdominal group. However there was no statistical difference in plasma keton body levels between the groups. Mild increases in plasma free fatty acid and blood lactate levels were detected during surgery in both groups to the same extent. Blood glucose increased significantly during surgery in both groups and the increase was statistically higher in the abdominal group than that in the non-abdominal group. The findings suggest that there is no difference in fat metabolism between non-abdominal and abdominal groups during surgical intervention lasting as long as 3 hours when patients are starved and do not receive any glucose during surgery.

Adolescent↗
PubMed1994

The initial distribution volume of glucose and cardiac output after haemorrhage in dogs.

The purpose of the study was to evaluate the role of insulin in glucose kinetics after glucose administration using an insulinogenic index to indicate the magnitude of insulin response. The initial distribution volume of glucose (IDV-G) was calculated with a one-compartment model from repeated measurements of plasma glucose concentration three to seven minutes after administration of 100 mg.kg-1 glucose. The IDV-G was compared with the insulin response and the thermodilution assessments of cardiac output, measured simultaneously both before and after induced haemorrhage (30 ml.kg-1 over 30 min) in 12 adult mongrel dogs. The plasma insulin concentration was measured during the procedure and insulinogenic indices were calculated. There was no correlation between the IDV-G and insulinogenic indices, but there was a correlation between the IDV-G and thermodilution cardiac output before and after induced haemorrhage (r = 0.85, n = 24, P < 0.001). We conclude that the initial distribution volume of glucose is an indication of cardiac output in normo- and hypovolaemic dogs. Modification of glucose kinetics by the insulin response to glycaemic stimuli was negligible in that short period of time.

Animals↗
PubMed1994

[Hormonal changes during removal of aldosterone-producing adrenal tumor under sevoflurane anesthesia].

We measured plasma aldosterone, cortisol, ACTH and catecholamine concentrations during removal of aldosterone-producing adrenal tumor under sevoflurane anesthesia in four adult patients. Sevoflurane anesthesia alone did not affect the plasma levels of aldosterone, cortisol, ACTH and catecholamine. Plasma aldosterone levels increased significantly with surgical stimulation and reached the peak value before surgical manipulation. Thereafter they declined in magnitude and reached the value below the peanesthetic levels at recovery from anesthesia. Plasma cortisol and ACTH levels increased significantly with surgical stimulation, and plasma ACTH levels reached the peak values after the emergence from anesthesia in the recovery room. Plasma catecholamine levels increased with surgical stimulation, but the increase in plasma epinephrine levels was more striking than that in plasma norepinephrine levels during surgical manipulation of the tumor. Hypertension during manipulation of the tumor was demonstrated to correlate with increase in plasma epinephrine levels but not with plasma aldosterone levels. Sevoflurane gave us no trouble during anesthetic management for removal of aldosterone-producing adrenal tumor. We conclude that sevoflurane anesthesia is a better choice for surgery for primary aldosteronism.

Adrenal Gland Neoplasms↗
PubMed1994

[Changes in rectal temperature during tympanoplasty under general anesthesia].

We measured rectal temperature of 35 patients who underwent tympanoplasty under various types of general anesthesia. They were allocated at random to three groups according to the types of general anesthesia; 10 patients of enflurane-N2O (enflurane group); 10 patients of neuroleptic anesthesia with droperidol, pentazocine-N2O (NLA group); 15 patients of total intravenous anesthesia with droperidol, fentanyl and ketamine (DFK group). After the induction of anesthesia, their rectal temperature was continuously monitored with an electric thermometer of NEC San-ei throughout the surgical procedure. Increase in rectal temperature was observed in all three groups, and increase in DFK group was significant compared with other two groups. It is possible that the significant increase in rectal temperature in DFK group is supposedly due to normally maintained hypothalamic thermoregulatory function as well as direct surgical stimulation to central nervous system.

Adult↗
PubMed1994

[Neuroleptanesthesia for a patient with mitochondrial encephalomyopathy].

This report describes a patient with mitochondrial encephalomyopathy who underwent an ophthalmic surgery under original neuroleptanesthesia. This 28-year-old female patient had been suffering from bilateral external ophthalmoplegia and blepharoptosis. Her preoperative neurological examination revealed a mitochondrial encephalomyopathy. Biopsy and blepharo-elevation for her left eyelid were scheduled. Anesthesia was induced with thiopental 5 mg.kg-1 and vecuronium 0.07 mg.kg-1, and maintained with total doses of 10 mg of droperidol, 400 micrograms of fentanyl and 4 mg of vecuronium. The patient recovered from anesthesia smoothly and her postoperative course was uneventful. Anesthetic management of patients with this disease and possible complications were discussed.

Adult↗
PubMed1994

[Emergency caesarean section for a patient with chronic schizophrenia].

A 39-year-old female with chronic schizophrenia underwent an emergency caesarean section under general anesthesia at her 39th week of gestation. A diagnosis of schizophrenia was made at 28 years of age and since then oral antipsychotic drugs, haloperidol and levomepromazine had been given orally. She had only taken haloperidol 4 mg per day between the 12th week of gestation and the day of surgery. At the 39th week of gestation, she developed a marked excitement which would have caused fetal distress. We decided to terminate her gestation. As the excitement was diagnosed as psychokinesis, we avoided using phenothiazine which might affect fetus and administered haloperidol 5 mg intramuscularly 210 and 30 minutes before emergency caesarean section. Anesthesia was induced with intravenous thiopental 300 mg and suxamethonium 60 mg. Pentazocine 30 mg in combination with nitrous oxide 70% in oxygen was given for the maintenance of anesthesia. During operation blood pressure was 160-180/80-90 mmHg, the heart rate was 90-100 beats.min-1. Hypertension and tachycardia might have been partially due to preoperative haloperidol. The induction-delivery time was 4 minutes 30 seconds. Plasma haloperidol levels were 23.8 ng.ml-1 in maternal venous blood and 8.8 ng.ml-1 in umbilical vein just after the delivery. The Apgar score was 7 at one minute and 8 at five minutes after delivery. The baby developed slight muscle weakness and poor sucking for two days after delivery and this was supposedly due to effect of preoperative haloperidol.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

[Plasma catecholamine levels in patients during surgical removal of pheochromocytoma under sevoflurane anesthesia].

We measured plasma catecholamine levels and hemodynamics in 5 patients during surgical removal of pheochromocytoma under sevoflurane anesthesia. Plasma catecholamine levels were unchanged with sevoflurane anesthesia. Plasma epinephrine, norepinephrine and dopamine levels increased 149 folds, 7.8 folds and 2.9 folds respectively as compared with preanesthetic values during surgical manipulation of the tumor, and then declined in magnitude but still remained 15 folds, 2.7 folds and 1.8 folds higher respectively as compared with the preanesthetic levels after removal of the tumor. These catecholamine levels finally reached 180%, 20% and 60% of the preanesthetic values respectively after the emergence from anesthesia in the recovery room. Mean systolic and diastolic arterial blood pressures were 127/82 mmHg before anesthetic induction and increased to 211/71 mmHg during manipulation of the tumor. Then they decreased to 75/52 mmHg immediately after removal of the tumor but recovered up to 126/71 mmHg on recovery from anesthesia. Alpha and beta adrenal blockers were administered if necessary to control hypertension and tachycardia during manipulation of the tumor. Hypotension after removal of the tumor was treated with volume replacement, vasopressor and/or catecholamines. No correlation was found between plasma catecholamine levels and arterial blood pressure in our study except during manipulation of the tumor. No arrhythmias were observed during anesthesia and surgery in our cases even though plasma catecholamines increased extremely with surgical intervention. We conclude that sevoflurane anesthesia is a better choice for surgery for pheochromocytoma.

Adrenal Gland Neoplasms↗
PubMed1994

[A marked elevation in serum CPK following sevoflurane anesthesia].

A one year-old girl with an arachnoid cyst received an arachnoid cystperitoneal shunt operation two tims, firstly under sevoflurane anesthesia, and secondarily under isoflurane anesthesia. After sevoflurane anesthesia, her serum CPK level increased markedly up to 7550 mU.ml-1, but such an increase was not observed following isoflurane anesthesia. The perioperative management was almost identical on these two occasions. A combination of sevoflurane anesthesia and succinylcholine might cause a significant increase in the serum CPK level.

Anesthesia, Inhalation↗
PubMed1994

[A gastric proton pump inhibitor as preanesthetic medication].

Effect of omeprazole, a gastric proton pump inhibitor, on gastric secretion during anesthesia and surgery was evaluated in 39 elective surgical patients ranged in age from 18 to 69 years. These patients were divided into two groups according to their age either of 40 years and under or over. The patients of both groups underwent orthopedic, ophthalmic, ENT, plastic, oral or non-abdominal surgery under neuroleptanesthesia, enflurane anesthesia or total intravenous anesthesia with droperidol, fentanyl and ketamine. They all were administered omeprazole 20 mg orally at 21:00 the night before surgery and again at 7:00 on the morning of surgery. The volume and acidity of gastric juice were measured at anesthetic induction and emergence from anesthesia. The volume and pH of the gastric juice in patients of 40 years and under in age averaged to 9.8 +/- 3.2 (mean +/- SE) ml, 2.45 +/- 0.56 at the anesthetic induction and 9.3 +/- 4.1 ml, 4.66 +/- 0.60 at the emergence from anesthesia respectively. The mean volume and pH of the gastric juice in patients over 40 years of age were 5.0 +/- 1.7 ml, 4.68 +/- 0.56 at the anesthetic induction and 9.9 +/- 2.4 ml, 5.76 +/- 0.36 at the emergence from anesthesia respectively. Significant decrease in the volume and acidity of gastric juice was observed in the patients of both groups except that the average of intragastric pH of the patients under 40 years of age was below 2.50 at the induction of anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1994

[Effect of pirenzepine on gastric secretion during anesthesia and surgery].

Effect of pirenzepine on gastric secretion during anesthesia and surgery was evaluated in 46 surgical patients ranged in age from 18 to 68 years. The patients underwent orthopedic, ophthalmic, ENT, plastic or non-abdominal general surgery under neuroleptanesthesia except two patients who had enflurane or isoflurane anesthesia. They received either pirenzepine 10 mg, 20 mg or the combination of pirenzepine 10 mg and famotidine 20 mg intravenously just before the induction of anesthesia. Volume and acidity of gastric juice were measured for 3 hours after the administration of these agents. Decrease in volume and acidity of gastric juice after pirenzepine 10 mg as well as after pirenzepine 20 mg continued for more than 3 hrs after the administration of the agents. Efficacy of the combination of pirenzepine and famotidine on gastric secretion was more prominent than that of pirenzepine alone in a double dose.

Adolescent↗
PubMed1993

The initial distribution volume of glucose and cardiac output in the critically ill.

Blood or plasma glucose concentration can be measured accurately and rapidly. However, after a glucose challenge metabolism may modify glucose kinetics, so that glucose has not been used as an indicator for dilution volumetry. To test the hypothesis that the initial distribution volume of glucose (IDVG) reflects cardiac output rather than glucose metabolism in the critically ill, the relationship between IDVG and thermodilution cardiac output was evaluated at 27 points in 13 non-surgical, critically ill patients without congestive heart failure. The IDVG was calculated from incremental plasma glucose concentrations using a one compartment model. Correlations were obtained between the IDVG and cardiac output (r = 0.89, n = 27, P < 0.001), and between the incremental plasma glucose concentrations three minutes after the injection and the IDVG (r = 0.94, n = 27, P < 0.001). No difference was found between the IDVG with or without continuous insulin infusions. The results indicate that the IDVG reflects cardiac output rather than glucose metabolism in patients without congestive heart failure.

Adult↗
PubMed1993

[Medical aspect of the winter march of the Fifth Regiment of the Eighth Military Division in the winter of 1902 - particularly concerning the cause of Major Yamaguchi's death].

Two hundred and ten military soldiers of the Fifth Regiment of the Eighth Division of the Japan Imperial Army joined a marching practice in the end of January, 1902, but 193 soldiers out of 210 died due to severe frost-bite during stormy weather and only seventeen, including Major Yamaguchi, were rescued to survive and brought to the Veteran's Administration Hospital at Aomori. This accident was most tragic and world-shaking for the Japanese people as well as for the Japanese Imperial Army. In December of 1991, an admission record of the Veteran's Administration Hospital at Aomori was found in the residence of Dr. Murakami of Aomori City. Judging from its handwriting, this record was written by a military physician Ki-ichi Murakami, Dr. Murakami's uncle. The record describes the details of seventeen patients, most of whom were severely injured and frost-bitten during the winter march. The content of this newly discovered record is similar to the report written by the military physicians of the Fifth Regiment which appeared in the Japan Imperial Military Medical Journal, but a more detailed description about Major Yamaguchi's vital signs, and symptoms of his frost-bite were found in the former. In the journal, Major Yamaguchi was reported to have died because of sudden cardiac arrest but Jiro Nitta described in his novel "Death March on Mount Hakkoda" that he committed suicide using his gun. However, this record strongly tells us that both of his hands, as well as both lower extremities, were severely frost-bitten and swollen and that he could not pull the trigger of his gun with his fingers. Since Jiro Nitta's novel has been published, it is widely accepted that Major Yamaguchi committed suicide with his gun. But we do not have any definite proof to substantiate his suicide. The present detailed survey on the medical references strongly suggests that he could not have pulled his gun's trigger by himself.

Frostbite↗
PubMed1993

[An application of a study of medical history to clinical medicine - for better understanding of medical history and its application to clinical medicine].

A study of medical history aims to correctly understand the progress in basic and clinical medical science and to effectively offer better medical service to our patients. The study of medical history has several important advantages, such as; 1) to understand the present medical science in depth and to shorten the duration of time needed to understand the present medicine, 2) to understand the disadvantages of the present medical sciences realizing that they are not perfect, 3) to correctly understand literature and historical documents on medical science, 4) to make and maintain accurate medical records and documents, 5) to create new concepts and 6) to prevent us from developing a rigid way of thinking. Two cases of the application of medical history to clinical medicine are shown. The first is in regard to perioperative blood transfusion. As it was suggested to me by a report that preoperative blood transfusion caused suppression of immune response in kidney transplantation, I thought a routine use of blood transfusion for surgical patients with malignant tumors would lead to a high postoperative recurrence rate of malignancy. Therefore, such a routine use of blood has been avoided inn our institution for these twenty years. The second case is in regard to excitement during the induction of inhaled anesthetics. At present the excitement is considered to be caused by inhibition of the cerebral cortical function. However, our recent clinical study based on Dr. Maeda's report published in 1935 has revealed that the excitement observed during the induction of inhaled anesthesia is caused mainly by stimulation of the trigeminal nerves. The importance of medical history should be much more stressed for medical training of students and residents as well as physicians. It should be widely and deeply applied to the clinical practice of medicine, though it is not so easy to do this. Otherwise, the study of medical history may be considered as only a hobby for retired physicians.

Clinical Medicine↗
PubMed1993

[Effects of sevoflurane anesthesia on serotonin metabolism in rat brain].

To elucidate the mechanism of general anesthesia, effects of sevoflurane anesthesia on serotonin metabolism in rat brain were studied. Three percent sevoflurane was administered for twenty minutes to Wistar male rats weighing 230-270g under spontaneous respiration. The rats were sacrificed by decapitation and the brains were rapidly removed. They were dissected into nine discrete regions, locus coeruleus, pons plus medulla oblongata, hypothalamus, thalamus, basal ganglia, midbrain, hippocampus, amygdala and cerebral cortex. The contents of serotonin (5-HT) and one of its major metabolites, 5-hydroxyindole-3-acetic acid (5-HIAA) were measured by high performance liquid chromatography with the dual-cell coulometric detector before anesthesia, 20 minutes after the start of anesthesia and at the recovery from anesthesia. Significant increases in 5-HT levels were observed in the pons, hypothalamus, midbrain, amygdala and cerebral cortex by sevoflurane anesthesia as compared with the control group. 5-HIAA levels decreased significantly in the thalamus by sevoflurane anesthesia, while an appreciable increase in 5-HIAA levels was observed in the basal ganglia at the recovery from anesthesia. It is concluded that 5-HT metabolism is significantly suppressed in the pons, hypothalamus, thalamus, midbrain, amygdala and cerebral cortex during sevoflurane anesthesia and this change in 5-HT metabolism may be associated with a mechanism of sevoflurane anesthesia.

Anesthesia, Inhalation↗
PubMed1993

[Clinical study on total intravenous anesthesia with droperidol, fentanyl and ketamine--20. Summary of three thousand cases and the future of this anesthetic method].

Total intravenous anesthesia with droperidol, fentanyl and ketamine (DFK) was given to over three thousand patients during four years from April 1989 through March 1993. The patients ranged in age from three months to eighty seven years. They underwent surgical, orthopedic, gynecological, thoracic, plastic and otolaryngeal surgeries, but patients who underwent craniotomy and obstetric operations were excluded. None of them developed any serious complications primarily due to DFK. DFK has many advantages such as the broad safety margin for three agents employed in DFK, no accident by N2O, no air pollution, empty bowels, no increase in middle ear pressure etc, while this has disadvantages such as high blood pressure, slow awakening from anesthesia and unpleasant dreams. Calcium channel blockers are very effective for antagonizing high blood pressure, and rapid recovery from anesthesia can be easily obtained by reducing ketamine dose given and also by application of epidural block. Intraoperative dreams may be avoided by concomitant use of benzodiazepines. Thus we are convinced that DFK can be a good as well as convenient anesthetic method for clinical anesthesia.

Adolescent↗