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Biomedical subjects

H Mitsuhata

Publications and source records attributed to H Mitsuhata.

At least 55 records · Page 3Linked to original sources
PubMed1995

[Psychological evaluation of out-patients in our pain clinic using self-rating depression scale and state-trate anxiety inventory questionnaire].

In 98 out-patients who visited our pain clinic, we evaluated their psychological status before the first examination and one month after the treatment, using self-rating depression scale (SDS) and state-trate anxiety inventory (STAI). SDS, state anxiety, and trate anxiety scores were significantly higher in the patients with pain (trigeminal neuralgia, neck-shoulder-arm pain syndrome, lumbago and psychological pain, n = 55) compared with the patients without pain (sudden deafness and facial nerve palsy, n = 43) (P < 0.01, 0.05, 0.01). Of the patients with pain, patients with psychogenic pain showed the highest score in every test. The scores of SDS and state anxiety became significantly lower one month after the treatments compared with ones before the first examination (P < 0.01). It was considered that the decline in every score was due to the treatments in our pain clinic. In patients whose score of trate anxiety before the first examination was more than 50 points, the SDS and state anxiety showed high scores even one month after the treatments. This finding suggests that these patients need psychosomatic managements.

Adult↗
PubMed1995

[Reevaluation of hypothermia as protective measures against cerebral ischemia].

Two patients underwent carotid artery ligation for the purpose of surgical hemostasis either under hypothermia or under normothermia. One was 56-year-old man with rupture of brachiocephalic artery following esophagectomy. The bilateral common carotid arteries were ligated for bypass-grafting between the right internal carotid artery and the left common carotid artery for 35 min under surface-induced hypothermia at a rectal temperature of 30.7 degrees C. No postoperative neurological deficit developed. The other was 40-year-old woman with a malignant parotid tumor involving left internal carotid artery. The left carotid artery was ligated for 20 min at a rectal temperature of 37.3 degrees C. Cerebral ischemia developed postoperatively. Mild to moderate hypothermia should be reevaluated as one of useful measures to protect the brain from cerebral ischemia.

Adult↗
PubMed1995

Role of nitric oxide in anaphylactic shock.

Nitric oxide, synthesized from the guanidino group of L-arginine by nitric oxide synthase, has an important role in pathophysiological changes associated with anaphylaxis. Nitric oxide production due to activation of constitutive nitric oxide synthase is detected using a nitric oxide-selective electrode in anaphylactic rabbits in vivo. A nitric oxide synthase inhibitor attenuates hypotension and hemoconcentration and decreases venous return but does not improve cardiac depression. Nitric oxide functionally antagonizes the effects of vasoconstrictors released by anaphylaxis in vitro. In animals pretreated with a nitric oxide synthase inhibitor, the cardiac output falls significantly, although venous return is increased. Pulmonary resistance is significantly increased with a nitric oxide synthase inhibitor, and L-arginine attenuates the bronchospasm. These findings suggest that production of nitric oxide may reduce the pathophysiologic changes, except for vasodilatation, associated with anaphylaxis.

Anaphylaxis↗
PubMed1995

Suppressive effects of volatile anesthetics on cytokine release in human peripheral blood mononuclear cells.

This study investigated the effects of three volatile anesthetics (sevoflurane, isoflurane, and enflurane) on cytokine release by human peripheral mononuclear cells (PBMCs) stimulated by natural killer (NK)-sensitive tumor cells, K562, in vitro. PBMCs, as effector cells, obtained from 31 volunteers were randomly allocated to two groups in the first set of experiments. One group was incubated with K562 (n = 21) and the other with medium alone as a control (n = 10). In a second set of experiments, PBMCs from each volunteer (n = 21) were divided into three groups: nonanesthetic, 1.5-MAC, and 2.5-MAC groups (n = 7 for each anesthetic). After 2 h exposure to anesthetic gas or air, K562 cells were added to the effector cells. After 4 h incubation, interleukin-1 beta (IL-1 beta), interleukin-2 (IL-2), tumor necrosis factor-alpha (TNF-alpha), and interferon-alpha (INF-alpha) in the supernatant were assayed. IL-1 beta and TNF-alpha levels were significantly increased in comparison with those in the control group. IL-2 levels tended to be higher than those in the control group. No effect on IFN-alpha levels was found. After anesthetic exposure, the releases of IL-1 beta and the release of TNF-alpha were significantly inhibited compared with those after air exposure. None of the anesthetics inhibited IL-2 release. The anesthetics studied are capable of altering the release of cytokines by NK and NK-like cells in response to tumor cells.

Anesthetics, Inhalation↗
PubMed1995

Extensive extradural spread in the elderly may not relate to decreased leakage through intervertebral foramina.

It has been suggested that the extensive longitudinal extradural spread of local anaesthetics in the elderly is attributed to decreased leakage through the intervertebral foramina. We have examined radiologically, in 53 patients, the relationship between leakage of iohexol through the thoracic intervertebral foramina and age. Iohexol was injected through an extradural catheter advanced 5 cm cephalad from one of the interspaces between T6 and T12. A significant correlation was observed between longitudinal spread of iohexol and age, but there was no correlation between leakage of iohexol through the intervertebral foramina and age. Our data suggest that longitudinal extradural spread of local anaesthetics in the elderly may not be attributed to decreased leakage through the intervertebral foramina.

Adult↗
PubMed1995

Heparin-protamine complexes cause pulmonary hypertension in goats.

BACKGROUND: Protamine reversal of heparin-induced anticoagulation causes thromboxane release followed by pulmonary vasoconstriction in sheep and pigs. The aim of this study was to determine whether heparin-protamine (H-P) complexes are causative agents of thromboxane release followed by pulmonary hypertension associated with protamine reversal of heparin. METHODS: We separated H-P complexes and non-heparin-protamine (non-H-P) complexes from heparinized defibrinated human plasma neutralized with protamine by chromatography and studied the changes in hemodynamics, airway pressure, and thromboxane B2 concentration after injection of H-P complexes or non-H-P complexes into seven goats. In addition, we studied whether these pulmonary responses were blocked in goats pretreated with cyclooxgenase inhibitor (Indomethacin, n = 5) or thromboxane synthetase inhibitor (OKY-046, n = 5). RESULTS: A very small dose of H-P complexes increased pulmonary arterial and peak airway pressures and was followed by thromboxane B2 release (from 12 [5.5-23] to 28 [16-44] mmHg, from 9.0 [7.5-15] to 12 [8-19] cmH2O, and from 0.85 [0.34-3.2] to 16.4 [1.4-39.3] ng.ml-1, respectively). On the other hand, animals that received non-H-P complexes showed no significant changes. Indomethacin totally blocked and OKY-046 partially blocked the increases in pulmonary arterial pressure and thromboxane B2 concentration. CONCLUSIONS: H-P complexes play a major role in pulmonary hypertension after protamine reversal of heparin, and thromboxane A2 is a main mediator of the pulmonary hypertensive response to H-P complexes in goats.

Animals↗
PubMed1995

Nitric oxide synthase inhibition is detrimental to cardiac function and promotes bronchospasm in anaphylaxis in rabbits.

We studied the effects of a nitric oxide synthase (NOS) inhibitor, N omega-nitro-L-arginine-methyl ester (L-NAME), on cardiac depression and bronchospasm provoked by systemic anaphylaxis in vivo in rabbits. Animals pretreated with L-NAME showed lower survival rates than control animals pretreated with normal saline. The survival rate in L-NAME-pretreated animals was increased by the administration of L-arginine after initiation of anaphylaxis. Cardiac output fell significantly in animals pretreated with L-NAME compared with controls, although venous return was increased. In animals pretreated with L-NAME, pulmonary resistance was significantly increased, and administration of arginine attenuated the bronchospasm. In conclusion, these results, along with the low survival rates in the L-NAME-treated animals, suggest that NO production may be beneficial to cardiac depression and bronchospasm in anaphylaxis in vivo.

Analysis of Variance↗
PubMed1995

Evaluation of left ventricular diastolic function in IgE-mediated anaphylaxis in dogs.

Depressed left ventricular (LV) systolic function remains controversial in patients with anaphylaxis and anaphylactic animal models. However, LV diastolic function has not yet been investigated in either patients or animal models. Therefore, we assessed LV diastolic and systolic function in IgE-mediated anaphylaxis in dogs. Seven dogs sensitized to Ascaris suum antigen were studied. An aqueous extract of Ascaris suum antigen was administered over 30 s into the systemic circulation to induce anaphylaxis. To assess LV function, the time constant of the fall of isovolumic LV pressure (T), as an index of LV diastolic function, and the maximum rate of rise of LV pressure (dP/dtmax), as an index of LV systolic function, were measured for a period of 120 min after antigen challenge. T was prolonged during the period of 5 to 15 min; however, changes in T were not significantly different from prechallenge values. LV d}/dtmax significantly decreased to 0.49 +/- 0.12 times the prechallenge value 5 min after antigen challenge, and significantly increased during the period from 30 to 120 min. However, these changes in dP/dtmax almost paralleled the changes in LV end-diastolic pressure, indicating that left ventricular systolic function was relatively well preserved. In conclusion, LV diastolic function, i.e., isovolumic relaxation, is little impaired in anaphylaxis, and LV systolic function is relatively well preserved during the early stage following the onset of anaphylaxis.

Anaphylaxis↗
PubMed1995

[Continuous monitoring of arterial blood oxygen saturation with a pulse oximeter during spinal anesthesia].

The arterial oxygen saturation was continuously monitored in 50 patients under spinal anesthesia. Of the 50 patients, low oxygen saturation below 95% and/or its decrease of more than 5% was observed in 19 patients (38%). The remaining 31 patients (62%) showed a normal oxygen saturation. Pentazocine 0.5 mg.kg-1 i.v. correlated significantly with arterial oxygen desaturation (P = 0.0001). It is possible that laparotomy is associated with the desaturation (P = 0.0582). No correlation between desaturation and the other factors (level of analgesia, position during operation, and hydroxyzine premedication) was found.

Adolescent↗
PubMed1995

[Effect of horizontal lithotomy position on spread of hyperbaric dibucaine spinal anesthesia].

We have studied the effect of horizontal lithotomy position on the spread of hyperbaric dibucaine spinal anesthesia. In three groups of 20 patients, 7.2 mg of hyperbaric dibucaine was injected intrathecally in the lateral decubitus position. In group supine, the patients were kept in supine horizontal position in which patient's legs and thighs were extended throughout the operation. In group lithotomy A, immediately after the spinal injection, the patients were placed into the lithotomy position. In group lithotomy B, after the spinal injection, the patients were placed immediately in the supine horizontal position for 15 min and then placed into the lithotomy position. There were no significant differences in height of sensory blockade among the three groups. The lithotomy position did not significantly affect the level of sensory blockade with hyperbaric dibucaine.

Adult↗
PubMed1995

[Rectal diclofenac coupled with continuous epidural infusion with buprenorphine and bupivacaine for pain relief after upper and lower abdominal surgery].

This investigation was conducted to determine the analgesic efficacy of rectal diclofenac coupled with continuous epidural infusion with buprenorphine and bupivacaine for pain relief after upper and lower abdominal surgery. Forty patients in control group received epidural buprenorphine 0.1 mg in 8 ml of 0.25% bupivacaine immediately after surgery and subsequently infusion was started with the solution of epidural buprenorphine 15 micrograms in 1 ml of 0.23% bupivacaine at a rate of 1 ml.h-1 for 48 h. Forty patients in study group received rectal diclofenac 50 mg immediately after surgery in addition to the same epidural injection method described above. Adding rectal diclofenac to continuous epidural infusion of buprenorphine and bupivacaine produced enhanced analgesia and reduced pain scores measured by VAS after upper abdominal surgery. However, after lower abdominal surgery, such effects of rectal diclofenac obtained after upper abdominal surgery were not demonstrable.

Abdomen↗
PubMed1995

An inhibitor of nitric oxide synthase, N omega-nitro-L-arginine-methyl ester, attenuates hypotension but does not improve cardiac depression in anaphylaxis in dogs.

We investigated whether a nitric oxide synthase (NOS) inhibitor improves cardiovascular depression associated with anaphylaxis. After induction of anaphylactic circulatory depression, one group received an NOS inhibitor (Group I, n = 6) and the other received saline solution (Group II, n = 5). Mean arterial pressure and right atrial pressure were significantly higher in Group I than in Group II. Hematocrit was significantly lower in Group I than in Group II. Cardiac output, stroke volume, mean pulmonary arterial pressure, the maximum rate of increase in left ventricular pressure, and the time constant of the fall in isovolumic left ventricular pressure did not differ between the groups. In conclusion, L-NAME attenuates hypotension, but does not improve cardiac depression in anaphylaxis in dogs. Our finding that NOS inhibitor did not improve cardiac function implies that the production of NO in anaphylaxis may have a protective effect with regard to cardiac performance.

Anaphylaxis↗
PubMed1995

[Lumbar epidurography with iohexol: the effect of aging on the leakage of contrast media from the intervertebral foramina].

The lateral and longitudinal spread of contrast media was investigated by lumbar epidurography with 8 ml of iohexol in 47 patients aged 25 yr to 86 yr. Iohexol was injected through the epidural catheter epidurally advanced by 5 cm cephalad from the L 1-4 interspace. A significant correlation was found between the longitudinal spread of iohexol and aging. No correlation was found between the leakage of iohexol from the intervertebral foramina and aging. This finding may deny the hypothesis that in elderly patients, the more extensive longitudinal spread of local anesthetics in the epidural space may be caused by its smaller leakage from the intervertebral foramina.

Adult↗
PubMed1995

[A radiological analysis of the position of lumbar epidural catheters: a comparison between median and paramedian approach].

The position of lumbar epidural catheters was confirmed by radiography in 71 patients. Catheters were advanced by 5 cm cephalad in the lumbar epidural space by paramedian approach (Group P: n = 28) or median one (Group M: n = 43) and contrast media was injected through the catheters. If the contrast media was present in the paravertebral regions, the catheter was considered to be in the abnormal position. The incidence of the abnormal position of the catheters was higher in group M than in group P significantly. To advance an epidural catheter longer into the lumbar epidural space, paramedian approach may be superior to median one.

Anesthesia, Epidural↗
PubMed1995

[Pulmonary hypertensive responses to erythrocytes components in sensitized rabbits].

Antigen erythrocytes cause a transient pulmonary hypertension in sensitized rabbits. We investigated the main responsible component in the antigen erythrocytes. Eleven rabbits were immunized intravenously with human O-N type erythrocytes every ten days until the agglutinin titer = 1:8,000 was obtained. Another ten rabbits without immunization served as a control group. Human erythrocytes were osmolitically hemolyzed and then separated into hemoglobin and membrane components by centrifugation. In sensitized rabbits, a bolus injection of human hemoglobin 0.7 ml.kg-1 caused increases in pulmonary arterial and airway pressures within 3-4 min. Increase in pulmonary arterial pressure after injection of hemoglobin component was significantly higher than that after injection of membrane component in sensitized rabbits. However, in nonsensitized rabbits both components were ineffective. Leukocytes counts decreased by 73-62% in sensitized rabbit, while they decreased by 16-37% in nonsensitized rabbits 5 min after injection of hemoglobin or membrane component. Platelets decreased by 54-61% in sensitized rabbits, while they decreased by 24-9% in nonsensitized rabbits 5 min after injection of hemoglobin or membrane component. We conclude that hemoglobin is the responsible component in the antigen erythrocytes and chemical mediators, such as thromboxane and platelet activating factor, may not be released from platelets and leukocytes.

Airway Resistance↗
PubMed1995

[Diagnosis of accidental subdural block].

Accidental subdural block occurred in a 47-year-old man who underwent gastrectomy under nitrous oxide-sevoflurane anesthesia combined with continuous epidural block. The development of subdural block was suspected from unexpectedly severe hypotension with small doses of mepivacaine during operation and was confirmed by a characteristic X-ray photograph after operation. The subdural block should be suspected from abnormal changes in vital signs and by careful observation of X-ray photographs, because it is not always easy to determine the presence of contrast media either in the subdural space or in the epidural space.

Anesthesia, Epidural↗
PubMed1995

[Patient's complaints preceding severe bradycardia and hypotension during spinal anesthesia].

We reported an episode of sudden bradycardia and hypotension during spinal anesthesia, in which the patient complained of nausea before the bradycardia and hypotension were recognized by the monitors, such as, intermittent measurement of arterial pressure, electrocardiography, pulse oxymetry and continuous arterial blood gas analysis. We emphasize the importance of strict vigilance during spinal anesthesia.

Aged↗