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F Goto

Publications and source records attributed to F Goto.

At least 37 records · Page 2Linked to original sources
PubMed2001

Electroconvulsive therapy impairs systolic performance of the left ventricle.

PURPOSE: In this observational study, we examined left ventricular systolic performance during electroconvulsive therapy (ECT), using an echocardiographic automated border detection system. METHODS: Nine ASA I or II patients scheduled for ECT were studied. Bilateral ECT was performed after the administration of propofol 1 mg x kg(-1), succinylcholine 1 mg x kg(-1), and assisted mask ventilation with 100% oxygen. Cardiac function was monitored by transthoracic echocardiography, prior to anesthesia induction and throughout the ECT procedure until ten minutes after the seizure. RESULTS: Increased end-systolic area and decreased fractional area change were observed at one minute after the seizure compared to the awake condition. No regional wall motion abnormalities were observed in all patients both at baseline condition and during the ECT CONCLUSION: Systolic performance of the left ventricle estimated by echocardiography decreased transiently in the immediate period after the electric shock.

Adult↗
PubMed2001

Hepatosplanchnic oxygenation is better preserved during mild hypothermic than during normothermic cardiopulmonary bypass.

PURPOSE: To assess and compare the effects of normothermic and mild hypothermic cardiopulmonary bypass (CPB) on hepatosplanchnic oxygenation. METHODS: We studied 14 patients scheduled for elective coronary artery bypass graft surgery who underwent normothermic (>35 degrees C; group I, n=7) or mild hypothermic (32 degrees C; group II, n=7) CPB. After induction of anesthesia, a hepatic venous catheter was inserted into the right hepatic vein to monitor hepatic venous oxygen saturation (ShvO(2)) and hepatosplanchnic blood flow by a constant infusion technique that uses indocyanine green. RESULTS: The ShvO(2) decreased from a baseline value in both groups during CPB and was significantly lower at ten minutes and 60 min after the onset of CPB in group I (39.5 +/- 16.2% and 40.1 +/- 9.8%, respectively) than in group II (61.1 +/- 16.2% and 61.0 +/- 17.9%, respectively; P <0.05). During CPB, the hepatosplanchnic oxygen extraction ratio was significantly higher in group I than in group II (44.0 +/- 7.2% vs 28.7 +/- 13.1%; P <0.05). CONCLUSION: Hepatosplanchnic oxygenation was better preserved during mild hypothermic CPB than during normothermic CPB.

Cardiopulmonary Bypass↗
PubMed2001

Perioperative management of biventricular failure after closure of a long-standing massive arteriovenous fistula.

PURPOSE: To report the perioperative management of arteriovenous fistula (AVF) closure in a patient with high-output heart failure and pulmonary hypertension. CLINICAL FEATURES: In a 71-yr-old man, closure of a long-standing massive AVF between the right femoral artery and vein was performed. After closure of the AVF, his pulmonary artery pressure (PAP) increased from 52/21 mmHg to 68/26 mmHg, his cardiac index decreased from 5.27 L.min(-1).m(-2) to 3.18 L.min(-1).m(-2), and his pulmonary wedge pressure increased from 15 mmHg to 32 mmHg due to an acute increase in afterload. Co-administration of prostaglandin E and a phosphodiesterase III inhibitor improved the cardiac index and the PAP. CONCLUSIONS: Surgical closure of the fistula may not always lead to resolution of the high output cardiac failure. In this case, afterload management using arterial dilators (prostaglandin E1, phosphodiesterase III inhibitor), use of inotropic drugs (phosphodiesterase III inhibitor), and close attention to volume status was crucial for a successful outcome after surgical AVF closure.

3',5'-Cyclic-AMP Phosphodiesterases↗
PubMed2001

Perilymph fistula--45 case analysis.

PURPOSE OF THE STUDY: Though perilymph fistula (PLF) is not a rare disease, preoperative diagnosis still remains to be established. Some new diagnostic methods are challenging, but there is still no established diagnostic method except exploratory tympanotomy that verifies the occurrence of leakage. Early diagnosis of PLF is fully depending on history taking and some clinical examinations. To know the clinical features of PLF is one of the greatest helps to make both earlier and accurate diagnosis. In spite of some innovations in clinical examinations classic diagnostic procedure is thought to be still reliable. PROCEDURES: We investigated the clinical symptoms, basic tests results and therapeutic results in patients with PLF. RESULTS: From 1983 to 1998 PLF was identified in 44 patients (45 ears) with exploratory tympanotomies in our hospital. With respect to clinical history the predisposing factors such as blowing the nose, lifting heavy goods, and landing in an airplane were found in almost half of the patients, while the rest of them had no clear inducing factors. Their major symptoms included hearing loss (93%), vertigo and dizziness (91%), tinnitus (76%), and aural fullness (31%). The patients who have a clear predisposing factor tended to make diagnosis easily; on the other hand the rest of the patients who do not have clear etiology had some diagnostic difficulty. Subjective positive fistula signs were observed in 71% of patients. Vestibular symptoms improved in 80% of patients after closure of PLF. CONCLUSIONS: These results suggest that the variety of clinical manifestation make diagnosis more difficult. At the moment meticulous clinical history taking and close follow-up applying repeating fistula tests are the most important for not only earlier but also accurate diagnosis.

Adolescent↗
PubMed2001

Effects of small doses of prostaglandin E(1) on systemic hemodynamics and jugular venous oxygen saturation during cardiopulmonary bypass.

STUDY OBJECTIVE: To examine the effects of small doses of prostaglandin E(1) (PGE(1)) on systemic hemodynamics and cerebral oxygenation during cardiopulmonary bypass(CPB). DESIGN: Randomized, prospective study. SETTING: Cardiac surgery at Saitama Cardiovascular and Pulmonary Center. PATIENTS: Forty patients who underwent elective coronary artery bypass surgery. INTERVENTIONS: The study was performed at the stable CPB period. Patients were randomly divided into four groups: control group (n = 10) received an infusion of saline, PGE(1) 10 group (n = 10) received an infusion of PGE(1) 10 ng/kg/min, PGE(1) 25 group (n = 10) received an infusion of PGE(1) 25 ng/kg/min, and the PGE(1) 50 group (n = 10) received an infusion of PGE(1) 50 ng/kg/min. MEASUREMENTS: After measuring the baseline partial pressure of the arterial oxygen saturation (SpO(2)), mixed venous oxygen saturation (SvO(2)), and jugular venous oxygen saturation (SjvO(2)), blood gases, and cardiovascular hemodynamic values, PGE(1) was infused intravenously at rate of between 10 and 50 ng/kg/min. PGE(1) infusion continued 30 minutes after the start of drug infusion, and the blood gas analysis and cardiovascular hemodynamic values were simultaneously determined together with the hemodynamic values at 2, 5, 10, 20, and 30 minutes during drug infusion. At 30 minutes after discontinuation of the drug infusion, the blood gas analyses were simultaneously determined together with the hemodynamic values. MAIN RESULTS: Mean arterial pressure (MAP) in PGE(1) 25 and 50 groups was decreased 20 and 30 minutes after the start of PGE(1) infusion compared with the baseline value (p < 0.05). In contrast, SvOm(2) in PGE(1) 25 and 50 groups was increased 20 and 30 minutes after the start of PGE(1) infusion compared with the baseline value (p < 0.05). There was no change in SjO(2) value despite a decrease in MAP during the study. CONCLUSIONS: Cerebral oxygenation estimated by SjvO(2) was maintained despite a decrease in MAP during the administration rate of PGE(1) between 10 and 50 ng/kg/min.

Aged↗
PubMed2001

Time course of changes in jugular venous oxygen saturation during hypothermic or normothermic cardiopulmonary bypass in patients with diabetes mellitus.

BACKGROUND: Preexisting diabetic mellitus is a risk factor determining postoperative neurological disorders. The present study assesses the effects of normothermic and hypothermic cardiopulmonary bypass (CPB) on jugular venous oxygen saturation (SjvO2)in patients with preexisting diabetic mellitus. METHODS: Sixteen diabetic patients who underwent elective coronary artery bypass grafting surgery were randomly divided into two groups: Group DN (n=8, diabetic patients) underwent normothermic CPB (>35 degrees C), and group DH (n=8, diabetic patients) underwent hypothermic CPB (32 degrees C). Controls were 16 age-matched non-diabetic patients (normothemic group, CN: n=8; hypothemic group, CH: n=8). A 4.0 F fiberoptic oximetry oxygen saturation catheter was inserted into the right jugular bulb to continuously monitor SjvO2 values. Hemodynamic parameters and arterial and jugular venous blood gases were measured seven times. RESULTS: Cerebral desaturation, which was defined as SjvO2 values below 50%, was observed during normothermic CPB in diabetic patients (at the onset of CPB: 46+/-3%, at 20 min after onset of CPB: 49+/-3%, means+/-SD, respectively). No cerebral desaturation occurred in diabetic and control patients during hypothermic CPB. CONCLUSIONS: Patients with preexisting diabetes mellitus experienced cerebral desaturation during normothermic CPB.

Aged↗
PubMed2001

Disturbances in hepatocellular function during cardiopulmonary bypass using propofol anaesthesia.

BACKGROUND AND OBJECTIVE: Serum hyaluronate is thought to be an indicator of derangement in hepatocellular integrity, and the change in serum hyaluronate is a useful indicator in various liver disorders. We assessed the changes in serum hyaluronate in patients undergoing coronary artery bypass graft surgery. METHODS: Eleven patients scheduled for elective coronary artery bypass graft surgery were studied. An oximetry oxygen saturation catheter was inserted into the right hepatic vein to permit monitoring of hepatic venous oxygen saturation. Perioperative measurements included: haemodynamic variables; systemic oxygen delivery and uptake; arterial, mixed venous and hepatic venous oxygen saturation; arterial and hepatic venous plasma concentrations of lactate, arterial ketone body ratio (ratio of acetoacetate to 3-hydroxybutyrate); and arterial and hepatic venous hyaluronate were measured. RESULTS: Arterial and hepatic venous hyaluronate increased during cardiopulmonary bypass compared with the prebypass period. These increases returned to prebypass values after the cessation of bypass (hepatic venous hyaluronate value at the prebypass period: 26 +/- 13 ng mL(-1), during bypass: 77 +/- 40 ng mL(-1); 1 h after bypass: 57 +/- 42 ng mL(-1); 6 h after bypass: 32 +/- 15 ng L(-1), 24 h after bypass; 62 +/- 21 ng mL(-1); mean +/- SD, P < 0.05). The arterial and hepatic venous hyaluronate during cardiopulmonary bypass was correlated with total bilirubin and hepatic venous lactate concentrations 6 h after bypass (arterial hyaluronate at cardiopulmonary bypass period vs. total bilirubin at 6 h after bypass; r=0.793, P=0.0036, hepatic venous hyaluronate during bypass vs. that at 6 h after bypass; r=0.795, P=0.0035). CONCLUSIONS: Hepatocellular integrity might be disturbed during cardiopulmonary bypass when propofol anaesthesia is used.

Alanine Transaminase↗
PubMed2001

Sevoflurane and nitrous oxide anaesthesia suppresses heart rate variabilities during deliberate hypotension.

BACKGROUND AND OBJECTIVE: Despite the fact that both general anaesthetics and hypotensive drugs influence autonomic nervous activity, no study has yet examined the heart rate variability during deliberate hypotension and general anaesthesia. The aim of this was to clarify the heart rate variability changes during deliberate hypotension under sevoflurane-nitrous oxide anaesthesia. METHODS: Autonomic nervous system activity in patients (n=45) subjected to deliberate hypotension during sevoflurane in nitrous oxide and oxygen anaesthesia was investigated by a heart rate variability measurement. Three different types of hypotensive drugs, a calcium channel antagonist (nicardipine), a nitric oxide donor (nitroglycerin) and a vasodilatory prostaglandin (alprostadil), were used to induce hypotension. RESULTS: In all groups, low frequency power (sympathetic and parasympathetic indicator) and the ratio of low frequency to high frequency power (the LF/HF ratio, sympathetic indicator) were suppressed by induction of anaesthesia. In the control group, preanaesthesia low frequency power was 195 +/- 139 ms(2), the LF/HF ratio 10.3 +/- 5.7, during anaesthesia 5 +/- 9 ms(2), 0.6 +/- 0.8, respectively, P=0.0093, 0.0034, whereas high frequency power (parasympathetic indicator) was not significantly changed. In those patients receiving nicardipine or nitroglycerin during anaesthesia, these variables did not differ significantly from those in the control group. During prostaglandin E1 infusion, high frequency power was higher compared with the values in the other groups (17 +/- 12 ms(2) in the prostaglandin group, 7 +/- 6 ms(2) in the nicardipine group, 6 +/- 5 ms(2) in the nitroglycerin group and 6 +/- 4 ms(2) in the control group, respectively, P=0.0326, 0.0251, 0.0197). CONCLUSIONS: Sevoflurane in nitrous oxide and oxygen anaesthesia reduces sympathetic autonomic activity considerably, and the expected increases caused by hypotensive agents that occur in awake volunteers were not seen.

Alprostadil↗
PubMed2001

N-methyl-D-aspartate receptor-dependent and -independent cytotoxic effects of Dictyostelium discoideum differentiation-inducing factor-1 on rat cortical neurons.

Differentiation-inducing factor-1 (DIF-1) is a chlorinated alkylphenone (small lipophilic hormone) that induces stalk cell formation in the cellular slime mold Dictyostelium discoideum. Recent studies have revealed that DIF-1 inhibits growth and induces the differentiation of mammalian tumor cells. The present study examines the effects of DIF-1 on rat cortical neurons in primary culture. We found that DIF-1 induced rapid neuronal cell death. The release of lactate dehydrogenase (LDH), as an indicator of cell death, increased dose-dependently with DIF-1. The release of LDH was inhibited by the N-methyl-D-aspartate (NMDA) receptor antagonists MK801 and AP5, suggesting that the NMDA receptor is involved in the induction of cell death by DIF-1. However, glutamate cytotoxicity could not explain the entire action of DIF-1 on neurons because the estimated concentration of glutamate around DIF-1-treated neurons was below 50 microM and DIF-1 caused more severe cell death than 500 microM glutamate. We discovered that another portion of DIF-1 cytotoxicity is independent of the NMDA receptor; that is, coaddition of DIF-1 and MK801 induced dendritic beading and increased expression of the immediate early genes c-fos and zif/268. These results indicate that DIF-1 induces rapid cell death via both NMDA receptor-dependent and -independent pathways in rat cortical neurons.

Animals↗
PubMed2001

Hydrothorax: an unexpected complication after laparoscopic myomectomy.

We report a case of hydrothorax as a complication of laparoscopic myomectomy in an otherwise healthy woman. The most likely cause of the patient's hydrothorax was irrigation fluid moving from the peritoneal cavity into the pleural space via defects in the diaphragm. Anaesthesists and surgeons should consider hydrothorax as a potential complication in any patient undergoing laparoscopy.

Adult↗
PubMed2001

Arytenoid dislocation while using a McCoy laryngoscope.

Arytenoid dislocation (AD) involves either a complete disruption of the cricoarytenoid joint or a malpositioning of the arytenoid cartilages (AC) with reference to other laryngeal cartilages. In this report, we present a case of AD while using a McCoy laryngoscope. Although McCoy laryngoscope is recognized as a useful option for the cases of difficult endotracheal intubation, we are concerned that AD is likely with this device.

Adult↗
PubMed2001

Direct neurotoxicity of tetracaine on growth cones and neurites of growing neurons in vitro.

BACKGROUND: Local anesthetics have direct neurotoxicity on neurons. However, precise morphologic changes induced by the direct application of local anesthetics to neurons have not yet been fully understood. Also, despite the fact that local anesthetics are sometimes applied to the sites where peripheral nerves may be regenerating after injury, the effects of local anesthetics on growing or regenerating neurons have never been studied. METHODS: Three different neuronal tissues (dorsal root ganglion, retinal ganglion cell layer, and sympathetic ganglion chain) were isolated from an age-matched chick embryo and cultured for 20 h. Effects of tetracaine were examined microscopically and by a quantitative morphologic assay, growth cone collapse assay. RESULTS: Tetracaine induced growth cone collapse and neurite destruction. Three neuronal tissues showed significantly different dose-response, both at 60 min and at 24 h after the application of tetracaine (P < 0.01). The ED50 values (mean +/- SD) at 60 min were 1.53+/-1.05 mM in dorsal root ganglion, 0.15+/-0.05 mM in retinal, and 0.06+/-0.02 mM in sympathetic ganglion chain cultures. The ED50 values at 24 h were 0.43+/-0.15 mM in dorsal root ganglion, 0.07+/-0.03 mM in retinal, and 0.02+/-0.01 mM in sympathetic ganglion chain cultures. Concentration of nerve growth factor in the culture media did not influence the ED50 values. The growth cone collapsing effect was partially reversible in dorsal root ganglion and retinal neurons. However, in the sympathetic ganglion culture, no reversibility was observed after exposure to 1 mM tetracaine for 10 or for 60 min. Bupivacaine had similar neurotoxicity to the three types of growing neurons. (The ED50 values at 60 min were 2.32+/-0.50 mM in dorsal root ganglion, 0.96+/-0.16 mM in retinal, and 0.18+/-0.05 mM in sympathetic ganglion chain cultures. The ED50 values at 24 h were 0.34+/-0.09 mM in dorsal root ganglion, 0.21+/-0.06 mM in retinal, and 0.45+/-0.10 mM in sympathetic ganglion chain cultures.) CONCLUSIONS: Short-term exposure to tetracaine produced irreversible changes in growing neurons. Growth cones were quickly affected, and neurites degenerated subsequently. Sensitivity varied with neuronal type and was not influenced by the concentration of nerve growth factor. Because a similar phenomenon was observed after exposure to bupivacaine, the toxicity to growing neurons may not be unique to tetracaine.

Anesthetics, Local↗
PubMed2001

High-concentration tetracaine for the management of trigeminal neuralgia: quantitative assessment of sensory function after peripheral nerve block.

OBJECTIVE: This study examined the effects of peripheral nerve block with high-concentration tetracaine for the management of trigeminal neuralgia, and evaluated sensory function by measuring the postblock current perception threshold. METHODS: Five infraorbital nerve blocks were performed in five elderly patients using 4% tetracaine dissolved in saline or 0.5% bupivacaine. The authors used a neurometer to compare postblock current perception threshold between the block side and the contralateral healthy side, and used cold tests to assess the sensory level. RESULTS: The analgesic effect of tetracaine blocks continued for a median period of 2 months (range, 1.5-months). Hypesthesia was observed in all patients after the block but resolved within a mean period of 2.2 weeks. Although differences in current perception threshold values between sides were not significant in any patient, block-side values in two patients were clinically higher than contralateral-side values (250 vs. 5 Hz) for some time before returning to normal levels. CONCLUSION: Peripheral nerve block with high-concentration tetracaine is a relatively safe and useful technique in the management of trigeminal neuralgia, particularly among older patients and those with systemic problems.

Aged↗
PubMed2001

Postlesional vestibular reorganization in frogs: evidence for a basic reaction pattern after nerve injury.

Nerve injury induces a reorganization of subcortical and cortical sensory or motor maps in mammals. A similar process, vestibular plasticity 2 mo after unilateral section of the ramus anterior of N. VIII was examined in this study in adult frogs. The brain was isolated with the branches of both N. VIII attached. Monosynaptic afferent responses were recorded in the vestibular nuclei on the operated side following ipsilateral electric stimulation either of the sectioned ramus anterior of N. VIII or of the intact posterior vertical canal nerve. Excitatory and inhibitory commissural responses were evoked by separate stimulation of each of the contralateral canal nerves in second-order vestibular neurons. The afferent and commissural responses of posterior vertical canal neurons recorded on the operated side were not altered. However, posterior canal-related afferent inputs had expanded onto part of the deprived ramus anterior neurons. Inhibitory commissural responses evoked from canal nerves on the intact side were detected in significantly fewer deprived ramus anterior neurons than in controls, but excitatory commissural inputs from the three contralateral canal nerves had expanded. This reactivation might facilitate the survival of deprived neurons and reduce the asymmetry in bilateral resting activities but implies a deterioration of the original spatial response tuning. Extensive similarities at the synaptic and network level were noted between this vestibular reorganization and the postlesional cortical and subcortical reorganization of sensory representations in mammals. We therefore suggest that nerve injury activates a fundamental neural reaction pattern that is common between sensory modalities and vertebrate species.

Animals↗
PubMed2001

The expression of a barley HvNAS1 nicotianamine synthase gene promoter-gus fusion gene in transgenic tobacco is induced by Fe-deficiency in roots.

Nicotianamine (NA) is a precursor for mugineic acid-family phytosiderophores, which are a critical component of the Fe aquisition process in graminaceous plants. In addition, nicotianamine synthase (NAS) is strongly induced in these plants by Fe deficiency. NA is essential for Fe metabolism also in dicots, but NAS is not induced by Fe deficiency. We introduced a barley HvNAS1 promoter-gus fusion gene into tobacco. GUS activity was induced in the roots of these plants by Fe deficiency, and was constitutively expressed at a low level in their leaves.

Alkyl and Aryl Transferases↗
PubMed2001

[Successful management of a patient who developed intra-operative pulmonary tumor embolism].

A 68-year-old female with retroperitoneal tumor extending into the inferior vena cava (IVC) developed massive pulmonary tumor embolism during removal of the tumor. Because of her unstable hemodynamics, emergency pulmonary embolectomy under cardiopulmonary bypass was performed. Successful management of her intra- and post-operative persistent right heart failure led to a satisfactory postoperative course without serious neurological complications. In peri-operative management of a patient with an extended tumor into IVC, prevention of the embolism, detection of the pulmonary embolism and treatment of intra- and post-operative right heart failure are important.

Aged↗