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Biomedical subjects

H Iwasaka

Publications and source records attributed to H Iwasaka.

At least 37 records · Page 2Linked to original sources
PubMed1996

Glucose intolerance during prolonged sevoflurane anaesthesia.

PURPOSE: The effects of prolonged sevoflurane anaesthesia on insulin sensitivity were investigated by two successive intravenous glucose tolerance tests (IVGTT) in eight patients who underwent prolonged surgery. METHODS: The first IVGTT was administered (25 g glucose as 20% dextrose in water iv) over two minutes 35 min after initiation of surgery. Arterial blood samples were obtained at 0, 5, 10, 30, 60, and 120 min after glucose administration for blood glucose and plasma insulin determination. A second IVGTT was performed six hours following the initiation of surgery. RESULTS: The disappearance rate of glucose (k-value) for the first IVGTT was 0.887 +/- 0.436 (mean +/- SD) %.min-1, and 0.784 +/- 0.289 for the second IVGTT. Both k-values are lower than the normal value. The maximum insulin response to glucose (delta IRI-delta BS-1) of the second IVGTT was lower than the first IVGTT (0.124 +/- 0.092 vs 0.071 +/- 0.056, P < 0.05). The total insulin output of the first IVGTT was higher than the second IVGTT (1.161 +/- 830 vs 568 +/- 389 microU.min.ml-1, P < 0.05). CONCLUSION: Glucose intolerance is enhanced by diminished insulin output in response to blood glucose elevation during prolonged anaesthesia and surgery.

Aged↗
PubMed1996

The clinical features of Tourette's disorder with obsessive-compulsive symptoms.

Twenty-three patients with Tourette's disorder (13 with obsessive-compulsive symptoms [OCS] and 10 without) were comparatively investigated. In contrast to OCS-free Tourette's disorder patients, those with OCS were found to be characterized by (i) a higher incidence of volatile temper, (ii) a higher incidence of compulsive tics, (iii) a higher incidence of perinatal disorders and brain wave abnormalities, (iv) a higher severity as rated using the Severity Scale, and (v) a higher prevalence of complications, especially of developmental disorders. Of the subjects with OCS-accompanied Tourette's disorder, approximately half had developed OCS by the onset of tics. These findings suggest the likelihood that OCS-accompanied Tourette's disorder is more strongly associated with organic cerebral disorders, independently of sites of tic disorders, than is OCS-free Tourette's disorder.

Adolescent↗
PubMed1995

Clinical features of childhood-onset schizophrenia with obsessive-compulsive symptoms during the prodromal phase.

Thirty-nine patients with schizophrenia, diagnosed according to DSM-III-R, who were under 15 years of age, were studied in two groups; 16 subjects with obsessive-compulsive symptoms during the prodromal phase, and 23 with no obsessive-compulsive disorders. The group with obsessive-compulsive symptoms during the prodromal phase was characterized by a higher ratio of males, higher incidences of perinatal and brain computed tomography (CT) abnormalities, fewer hereditary factors, longer duration of the prodromal phase, and a higher incidence of insidious onset and negative symptoms compared with the group without such prodromal symptoms. Schizophrenic patients with obsessive-compulsive symptoms during the prodromal phase were clinically distinct from those without, which suggests the possibility of subtype categorization.

Adolescent↗
PubMed1995

[The comparison of hypnotic potency of nitrous oxide with that of sevoflurane: evaluation by the middle latency auditory evoked response].

In 10 consented patients (ASA I-II) we quantitated the hypnotic potencies of 0.7 MAC nitrous oxide and 0.7 MAC sevoflurane by measuring auditory evoked response (AER), and compared the hypnotic potency of nitrous oxide with that of sevoflurane at the same MAC. In each patient, measurements of AER waves were performed in the following three stages, 0.7 MAC nitrous oxide, 0.7 MAC sevoflurane and 0.7 MAC nitrous oxide after induction of anesthesia. Analysis of variance was used to compare the hypnotic potencies between two inhaled anesthetics. Pa and Nb latencies with sevoflurane were longer than those with nitrous oxide, and Pa and Nb amplitudes with sevoflurane were greater than those with nitrous oxide. However, we found that there were no statistical significances in our results. In conclusion, nitrous oxide exerts as much hypnotic effect as sevoflurane.

Analysis of Variance↗
PubMed1995

The effects of imipramine, amitriptyline and clonidine administered by iontophoresis on the pain threshold.

We performed iontophoresis of aqueous solution of imipramine and amitriptyline, tricyclic antidepressant, and clonidine, an alpha 2 agonist, in a total of 30 healthy adult volunteers. Analgesic effects were compared among the 3 drugs by measurement of the pain threshold using a thermopainmeter. No significant changes in the pain threshold were observed with imipramine or amitriptyline. On the other hand, clonidine significantly increased the pain threshold, compared with the control value before iontophoresis. Although the effects of iontophoresis of clonidine were smaller than the previously reported effects of iontophoresis with other drugs, these effects seemed to be due to the action of clonidine itself not associated with electric stimulation. More marked effects may be obtained with changes in the conditions of iontophoresis.

Adrenergic alpha-Agonists↗
PubMed1994

Porphyromonas gingivalis fimbriae induce a 68-kilodalton phosphorylated protein in macrophages.

The present study was performed to examine whether Porphyromonas gingivalis fimbriae induce specifically a protein kinase-mediated phosphorylated protein that is involved in the mechanism of signal transduction. The fimbriae induced a 68-kDa phosphorylated protein (pp68) in a dose-dependent manner in mouse peritoneal macrophages. A marked appearance of pp68 was observed 20 min after the initiation of fimbrial treatment. The fimbria-induced pp68 was inhibited dramatically by staurosporine, a potent inhibitor of protein kinase C. pp68 induction was also inhibited by H-7, a potent inhibitor of several types of protein kinase. However, the induction was not inhibited by HA-1004 and H-8, relatively high-affinity inhibitors of protein kinase A. Phorbol myristate acetate and 1-oleoyl-2-acetyl-sn-glycerol, activators of protein kinase C, were able to induce pp68 in mouse peritoneal macrophages. This protein was localized in the cytosolic fraction of fimbria-treated macrophages. pp68 also was induced in fimbria-treated human monocyte-like cells. Finally, we observed that gene expression of the fimbria-induced neutrophil chemoattractant KC was inhibited markedly by staurosporine.

Alkaloids↗
PubMed1994

[Effect of pirenzepine on gastric mucosal blood flow in patients after cardiac surgery].

Effect of pirenzepine on gastric mucosal blood flow (GMBF) in adult patients after coronary artery bypass grafting and mitral and aortic valve replacement was evaluated by using endoscopic laser-Doppler velocimetry. Heart rate, blood pressure and cardiac output increased temporarily after intravenous administration of pirenzepine 20 mg. GMBF also increased with these hemodynamic changes. However, GMBF remained significantly higher even after the decrease of cardiac output. Therefore, the increase in GMBF, which might be due in part to increase in cardiac output, could be explained by pirenzepine's own effect on gastric mucosa. Since the GMBF is one of the most important gastric mucosal defensive factors, pirenzepine may be useful in preventing acute gastric mucosal lesions in patients with low cardiac output.

Aged↗
PubMed1994

[Evaluation of a new nitric oxide delivery system during mechanical ventilation].

A new nitric oxide delivery and continuous monitoring system is described. During mechanical ventilation, this new system connected with Siemens Servo 900C ventilator was shown to be able to provide a constant inspired NO concentration (10-100 ppm) using chemiluminescence technique for NO analysis. Gas was analysed at the mixing chamber in front of the ventilator inlet and inspiratory tube connected with the soda-lime carbon-dioxide absorber. Both NO concentrations showed a good correlation (r = 0.99). The actual NO concentration from the NO supply cylinder was 1154 ppm and NO2 concentration was 14 ppm. In mongrel dogs, after 20 minutes of NO inhalation (10-100 ppm), the blood methemoglobin level reached a peak value of 2.2% starting from the pre-inhalation level of 0%. To optimize the safety of the clinical application of NO, its concentration should be measured continuously with chemiluminescence technique.

Animals↗
PubMed1994

[Perioperative management of the patient with hypertrophic obstructive cardiomyopathy].

We experienced the perioperative management of a patient with hypertrophic obstructive cardiomyopathy, who underwent open heart surgery. We performed three kinds of overload examinations, which included overdrive test using the pacemaker, continuous dopamine infusion with overdrive test and continuous diltiazem infusion with overdrive test, before and after cardio-pulmonary bypass under observation of the cardiac performances with transesophageal echocardiogram. We gained some important and interesting informations about the cardiac reserve of the patient. We could perform adequate perioperative management for the patient, taking the results of overload examinations into consideration.

Aged↗
PubMed1993

N-acetyl-D-galactosamine inhibits TNF-alpha gene expression induced in mouse peritoneal macrophages by fimbriae of Porphyromonas (Bacteroides) gingivalis, an oral anaerobe.

Adherence to host cells is an essential step in the initiation of most infectious diseases. It is well known that bacterial fimbriae may be involved in the adherence. Porphyromonas (Bacteroides) gingivalis is a pathogenic organism of adult periodontitis which is a chronic inflammatory disease. Using an experimental system for fimbria-induced TNF-alpha gene expression in mouse peritoneal macrophages, we examined the role of sugar moieties in the adhesion of P. gingivalis fimbriae to these cells. The fimbriae strongly induced TNF-alpha gene expression in the macrophages, and marked TNF activity toward fibroblasts was observed in culture supernatants of the fimbria-treated cells. The potent expression of TNF-alpha was inhibited by N-acetyl-D-galactosamine, but not inhibited by D-mannose, alpha-lactose, and alpha-L-rhamnose, D-galactose, and N-acetyl-D-glucosamine.

Acetylgalactosamine↗
PubMed1993

Hemodynamic and oxygen delivery-consumption changes during partial liver resection.

The effects of partial liver resection on hemodynamics and the oxygen delivery-consumption relationship were evaluated in ten patients with hepatocellular carcinoma. The cardiac index and oxygen delivery were increased significantly (P < 0.05) at 30 minutes after incision, 30 min after liver resection and in the recovery room. Oxygen delivery decreased significantly (P < 0.05) during liver resection. Oxygen consumption remained low throughout the procedure. We did not discover any flow-dependent change in oxygen consumption. Although our patients persisted a hyperdynamic state throughout surgery, their arterial ketone body ratio remained low. Therefore, it may be necessary to maintain a hyperdynamic state during partial liver resection in order to increase hepatic blood flow.

Journal Article↗
PubMed1993

[Intranasal administration of nitroglycerin solution and nitroglycerin spray during general anesthesia].

Nitroglycerin spray is a newly developed nitroglycerin (TNG) form, which delivers 0.3 mg of TNG with each spray emission. We compared the efficacy of intranasal administration of TNG spray and that of TNG solution during general anesthesia. Nineteen patients were randomly assigned to receive either 0.3 mg TNG solution (Solution group) or 0.3 mg TNG spray (Spray group) intranasally. Peak elevation of plasma TNG occurred 2 min after drug administration in both groups, and the plasma level decreased to an ineffective level after 10 min. The plasma TNG of the spray group was significantly higher than that of the solution group for 3 min. Two min after drug administration, systolic blood pressure decreased significantly in both groups, and this level persisted for 10 min. Diastolic blood pressure also decreased in the spray group, but not in the solution group. Heart rate increased significantly in both groups 2 min after drug administration. Oxygen index (PaO2/FIO2) decreased significantly in both groups, and the level persisted 10 min after administration. Although no significant differences were found between two nitroglycerin forms in any of these hemodynamic and respiratory parameters, nitroglycerin spray may have clinical advantages because of reliability in its effect, ready availability, ease of application and high stability.

Administration, Intranasal↗
PubMed1993

[Interleukin-6 and glucocorticosteroid responses to cardiopulmonary bypass].

The responses of interleukin-6 (IL-6), ACTH, cortisol, WBC, CRP to cardiopulmonary bypass (CPB) were studied in 5 patients who underwent elective CABG (N = 4) and AVR (N = 1). IL-6 started to increase from 3 h after the beginning of the operation at which aortic clamp was removed and reached a peak after 4 h at which CPB was withdrawn. ACTH also reached a peak after 4 h. The increase of cortisol started from 2 h when aorta was clamped, which was earlier than that of IL-6. IL-6 and ACTH fell sharply to pre-CPB levels before first postoperative day (1 POD) while cortisol remained high postoperatively. CRP level and WBC counts were maximum at 2 POD. The results suggest that the cortisol response to CPB is not only caused by IL-6, but also by other factors, such as IL-1 and TNF.

Adrenocorticotropic Hormone↗
PubMed1993

[Anesthetic management of a patient for giant pulmonary bulla drainage].

Recently it is claimed that the drainage procedure may be a useful method for giant pulmonary bulla in compromised patients. We reported the anesthetic managements of three patients with giant bulla for these procedures. We chose epidural anesthesia in order to prepare for the postoperative analgesia and the expansion of surgical procedure. In selecting circulatory support method, care was taken to choose dobutamine that would cause no suppression of hypoxic ventilatory drive. There is no doubt that right ventricular function is particularly important in patients with chronic obstructive lung disease. We measured right ventricular ejection fraction by thermodilution method and end-tidal CO2 by nasal cannula. These measurements may be useful methods for perioperative monitoring.

Aged↗
PubMed1993

[Cortisol responses to rapid ACTH test in patients with multiple organ failure].

Cortisol concentrations are usually elevated in sepsis, during major surgery and in burns. Adrenocortical response to stress seems to be essential for survival. To investigate the endogenous adrenocortical response to multiple organ failure, rapid ACTH stimulation tests were used in 15 patients. Patients were divided to nonsurvival group and survival group. Patients in both groups appeared to have increased adrenocortical activity, because basal cortisol concentrations were above normal (non-survival group: 33.8 +/- 13.7 micrograms.dl-1, survival group: 19.1 +/- 3.8). There are no significant differences between the two groups. We could not find absolutely adrenal insufficient patient. Plasma cortisol concentrations increased significantly in patients of both groups following ACTH stimulation. We found poor response to ACTH in two patients in non-survival group with very high basal cortisol concentrations. But there is no significant difference of cortisol response between the two groups. We could not determine whether the high mortality is associated with poor response to ACTH or not.

Adrenal Cortex↗
PubMed1993

[Evaluation of blood purification in perioperative acute renal failure].

The technical aspects of blood purification have made a great progress during 1980's. We reviewed our experiences of blood purification for the past six years. Between 1986 to 1991, we treated 48 perioperative patients with acute renal failure (ARF). Four were intraoperative cases and 46 were postoperative cases. Three of four intraoperative patients received major cardiovascular surgery, and hemodialysis was connected directly to ECC in these three cases, and in other one case, ARF was treated with continuous hemofiltration (CHF). There was no intraoperative complication. One patient died of septic multiple organ failure (MOF), but other three patients were discharged uneventfully. Thirty five postoperative ARF patients showed oliguric ARF, and their major causes were LOS (65%) and septic shock (29%). We treated these ARF patients with CHF combined with HD (63%), CHF only (28%) and HD only (9%). There were 21 deaths (60%) in this group and most common cause of death was septic MOF. Eleven postoperative ARF patients showed non-oliguric renal failure, and major cause of this type of ARF was thought to be aortic dissection and relative hypotension (45%). We treated these non-oliguric ARF patient with HD only (73%) and HD combined with CHF (27%). One of these non-oliguric ARF patients died from ARDS.

Acute Kidney Injury↗