Search PubMed⌕ Search

Biomedical subjects

K Fujise

Publications and source records attributed to K Fujise.

At least 37 records · Page 2Linked to original sources
PubMed1998

High intra-abdominal pressure increases plasma catecholamine concentrations during pneumoperitoneum for laparoscopic procedures.

BACKGROUND: Laparoscopic procedures are associated with several complications, such as hemodynamic, respiratory, and endocrine complications. In our previous clinical study, plasma epinephrine and norepinephrine concentrations remained unchanged after the insertion of a Veress needle, but increased significantly immediately after insufflation with carbon dioxide into the peritoneum. The mechanisms for this increase are unknown. OBJECTIVE: To investigate whether gas insufflation during pneumoperitoneum affects plasma catecholamine concentrations during laparoscopic procedures. DESIGN: Experimental study in pigs. MAIN OUTCOME MEASURES: The plasma concentrations of epinephrine and norepinephrine were measured in the pigs before and after pneumoperitoneum. The mean arterial pressure, heart rate, cardiac output, and arterial blood gas levels were measured, and the systemic vascular resistance was calculated. INTERVENTION: Air, nitrous oxide, or carbon dioxide were insufflated in turn into the peritoneal cavity of supine pigs. Thereafter, carbon dioxide was insufflated into the peritoneal cavity while the pig was in the left lateral decubitus position, and then in the right lateral decubitus position. Measures were performed before pneumoperitoneum and at the intra-abdominal pressures of 10 mm Hg and 20 mm Hg. One hour of resting time was allowed between each procedure. RESULTS: As compared with baseline values, the plasma concentrations of epinephrine and norepinephrine remained unchanged at 10 mm Hg but increased significantly at 20 mm Hg regardless of the gas used for the pneumoperitoneum (P<.05). The type of gas and differences in the position of the animals had no effect on the plasma epinephrine and norepinephrine concentrations. CONCLUSIONS: Excessive intra-abdominal pressure, but not the type of gas or body position, increases plasma catecholamine concentrations during the insufflation of gas into the abdominal cavity. Therefore, excessive insufflation of the pneumoperitoneum should be avoided.

Abdomen↗
PubMed1998

The effects of the lateral position on cardiopulmonary function during laparoscopic urological surgery.

UNLABELLED: Laparoscopic urological surgery is usually performed transperitoneally with retroperitoneal insufflation of carbon dioxide (CO2) in the lateral position. We studied whether a difference in the side of lateral position affected hemodynamic and pulmonary functions during pneumoperitoneum. Fifteen patients (eight in the right and seven in the left lateral position) undergoing elective laparoscopic urological surgery were studied under general anesthesia. Hemodynamic variables and blood gas data were recorded. Before insufflation, mean arterial pressure (MAP), mean pulmonary arterial pressure (MPAP), central venous pressure (CVP), and pulmonary capillary wedge pressure (PCWP) in the right lateral position were higher than those in the left lateral position. Pneumoperitoneum increased MAP, MPAP, CVP, PCWP, and cardiac index but decreased systemic vascular resistance in the right lateral position. Similar changes occurred during pneumoperitoneum in the left lateral position, but the changes were less than those in the right lateral position. The respiratory index (PaO2/PAO2), intrapulmonary shunt, and SpO2 did not change during pneumoperitoneum in either lateral position. Changing the side of the lateral position affected hemodynamic function but did not affect pulmonary oxygenation during pneumoperitoneum. IMPLICATIONS: The right and left lateral positions produced different hemodynamic changes during laparoscopic urological surgery. The increases in preload and cardiac index and the decrease in systemic vascular resistance were greater in the right than in the left lateral position. Respiratory changes were not affected differently between the right and left lateral positions.

Anesthesia, General↗
PubMed1998

Hepatitis B virus variants in patients with acute hepatitis in whom various clinical forms develop.

Ten patients who suffered from acute hepatitis with various clinical forms due to hepatitis B virus (HBV) were studied. HBV variants with a mutation in the precore region were dominant in two patients with fulminant hepatitis and in a patient with the most severe acute hepatitis. However, these mutant viruses were not detected in a patient who had the fulminant form of acute HBV infection on chronic liver damage or in most patients who had severe acute hepatitis. Furthermore, mutant viruses were also not detected in a patient with complicating myopathy and in one who had an atypical clinical course with three transaminase peaks. These results suggest that precore mutants may be involved in the pathogenesis of some cases of severe acute hepatitis, the same as for fulminant hepatitis, but not in other clinical forms of acute hepatitis.

Acute Disease↗
PubMed1998

Hoarseness after cardiac surgery.

OBJECTIVE: To investigate the incidence, severity, and duration of hoarseness after adult cardiac surgery and to examine movement of the endotracheal tube (ETT) during neck extension for sternotomy. DESIGN: Prospective study. SETTING: University hospital. PATIENTS: Seventy-two adults undergoing elective cardiac surgery (assessment of hoarseness was completed in 68). INTERVENTIONS: An ETT with an internal diameter of 8.0 mm and 7.5 mm was used for men and women, respectively. After surgical positioning, the ETT was placed with its tip about 3 cm above the carina. MEASURES: ETT migration during positioning for sternotomy was measured using a fiberoptic bronchoscope. Hoarseness was examined at 6-12 hrs after extubation. RESULTS: The ETT moved away from the carina during surgical positioning and the migration was 11+/-6 (1-27) mm [mean+/-SD (range)]. Hoarseness occurred in 32% of the patients (22/68), of whom five (23%) were grade 1 on a four-point scale (0-3), 14 (64%) were grade 2, and three (14%) were grade 3 (aphonic). The duration of hoarseness was 4+/-3 (1-14) days, except in one patient with left vocal cord paralysis (60 days). When this patient was excluded, intubation time was an independent predictor of the severity of hoarseness (p=0.0001). CONCLUSIONS: Hoarseness after cardiac surgery is common. Most hoarseness is transient and its severity is predicted by duration of intubation. Positioning for sternotomy displaces the ETT cuff away from the carina. This may cause persistent hoarseness because displaced cuff from trachea to larynx may damage the recurrent laryngeal nerve or vocal cords.

Cardiac Surgical Procedures↗
PubMed1997

Differential effects of endothelin receptor activation on cyclic flow variations in rat mesenteric arteries.

BACKGROUND: Cyclic flow variations (CFVs) represent repetitive cycles of platelet adherence-aggregation and vasoconstriction, followed by dislodgment of platelet thrombi and restoration of blood flow at the site of vascular injury. Although activation of endothelin A (ETA) and endothelin B (ETB) receptors leads to vasoconstriction and nitric oxide release, respectively, the roles of endogenous endothelin-1 (ET-1) and its receptors in CFVs are unknown. METHODS AND RESULTS: A side branch of a mesenteric artery of male Wistar rats was cannulated and a short segment of the artery was mechanically injured to induce CFVs. After 20 minutes of saline infusion, either saline (negative control), BQ-123 (ETA receptor antagonist, 10 microg/min), BQ-788 (ETB receptor antagonist, 10 microg/min), or sarafotoxin S6c (ETB receptor agonist, 10 ng/min) was infused for 20 minutes from the side branch into the injured arterial segment. Percent (%) luminal stenosis as well as proximal and distal vessel diameters were observed and quantitatively measured every minute using intravital video microscopy and a micrometer-calibrated video screen. Both BQ-123 and sarafotoxin S6c significantly reduced CFVs represented by the mean luminal stenosis (BQ-123=29+/-13% and sarafotoxin S6c=27+/-11% reduction, respectively; P<.05 for both, compared with saline). In contrast, BQ-788 significantly increased CFVs (33+/-6% increase, P<.05 compared with saline). Moreover, the inhibitory effect of sarafotoxin S6c on CFVs was completely abolished in the presence of N(omega)-nitro-L-arginine methyl ester (L-NAME) (a nitric oxide synthase inhibitor, 10(-5) mol/L) in superfusate over the arteries (16.1+/-5% increase, P=NS compared with saline in the presence of L-NAME). In addition, BQ-123 caused a significant increase in the diameter of the vessel distal to the injured segment (12+/-4% increase, P<.05 compared with saline). CONCLUSIONS: Endogenous ET-1 release from sites of vascular injury contributes to CFVs and vasomotor tone in the rat mesenteric artery CFV model. ETA and ETB receptors have differential roles in CFVs: ETA receptor antagonism and ETB receptor stimulation reduce CFVs, the latter at least partially through increased nitric oxide formation.

Animals↗
PubMed1997

Preferential interaction of sentrin with a ubiquitin-conjugating enzyme, Ubc9.

Sentrin is a ubiquitin-like molecule that has been shown to interact with the death domains of Fas and tumor necrosis factor receptor 1 (TNFR1), PML, Rad51, Rad52, and RanGAP1. We have reported previously that sentrin can be conjugated to other proteins in a manner analogous to protein ubiquitination (Kamitani, T., Nguyen, H. P., and Yeh, E. T. H. (1997) J. Biol. Chem. 272, 14001-14004). Furthermore, the conserved C-terminal Gly-Gly residues are required for sentrinization to occur. To identify enzymes which play a role in sentrinization, the yeast two-hybrid system was used to screen a human placenta cDNA library using sentrin as bait. A strong positive interacting clone was found to contain a cDNA insert encoding the ubiquitin-conjugating enzyme, Ubc9. The interaction between sentrin and Ubc9 required the ubiquitin domain and the C-terminal Gly-Gly residues of sentrin. This interaction appears to be specific because sentrin could only interact weakly with UbcH5B, but could not interact with HHR6B, UbcH6 nor E2-EPF. In vitro translated sentrin could be precipitated by a GST-Ubc9 fusion protein, but not by glutathione S-transferase. A beta-mercaptoethanol-sensitive Ubc9-sentrin conjugate could also be identified in the in vitro binding assay. Substitution of the conserved cysteine residue of Ubc9 by serine abolished the formation of the Ubc9-sentrin conjugate. Taken together, Ubc9 is a strong candidate to be the key conjugating enzyme in the sentrinization pathway.

Binding Sites↗
PubMed1997

A tissue plasminogen activator/P-selectin fusion protein is an effective thrombolytic agent.

BACKGROUND: P-selectin is expressed on the surface of activated endothelial cells and platelets. We hypothesized that a tissue plasminogen activator (TPA)/P-selectin fusion protein would have not only thrombolytic activity but also might target TPA to the thrombi. In addition, it seemed possible that this chimeric protein would competitively inhibit the binding of native P-selectin on endothelial cells and platelets to leukocytes and thus further promote thrombolysis. METHODS AND RESULTS: The full-length, plasminogen activator inhibitor-1-resistant form of TPA (TPAIR) together with two TPAIR/P-selectin fusion constructs (P280IR and P121IR) were expressed with the use of baculovirus vectors. After infection of Sf21 cells with the recombinant baculovirus, recombinant TPAIR and P-selectin/TPAIR fusion proteins were purified with the use of metal ion chromatography. The intact protease activity of TPAIR and the ligand binding capability of P-selectin were confirmed through indirect chromogenic and cell binding assays, respectively. These molecules were assessed both in vitro and in vivo for thrombolytic activity. In vitro clot lysis assays indicated equal efficacy of TPAIR, P280IR, and P121IR (P > .5). The in vivo efficacy was tested in a cyclic flow variation model with the use of the rat mesenteric artery. Compared with saline control treatment, reduction in cyclic flow variations was significant (P < .05) and similar (P > .5) among TPAIR, P280IR, and P121IR. No significant bleeding was noted among treated animals. CONCLUSIONS: Chimeric proteins P280IR and P121IR have clot lysis activities that are similar to TPAIR both in vitro and in vivo. These chimeric proteins also bind to P-selectin ligand in vitro. Thus, these proteins may provide an efficient method of targeting TPA to the thrombotic region. Further experimental analysis with the use of larger animal coronary occlusion models should help determine the future value of these proteins as clinical therapeutic agents.

Animals↗
PubMed1997

Infrapopliteal transcatheter interventions for limb salvage in diabetic patients: importance of aggressive interventional approach and role of transcutaneous oximetry.

OBJECTIVES: This study sought to determine whether infrapopliteal transcatheter interventions can salvage ischemic limbs in diabetic patients referred for below the knee amputation at our institution. BACKGROUND: The value of transcatheter interventions in diabetic crural arteries is controversial. Tissue oxygen partial pressure (TCO2) levels < 40 mm Hg predict poor wound healing. METHODS: Percutaneous interventions were performed in 29 consecutive diabetic patients in need of limb salvage. Technical success was defined as < 20% residual vessel stenosis. Clinical success was defined as the avoidance of amputation and achievement of wound healing. At hospital discharge, patients were treated with Coumadin and aspirin. Ankle-brachial index (ABI) and TCO2 measurements were obtained before and after the intervention. RESULTS: After 12-month follow-up, six patients had presistent wounds, whereas 23 experienced wound healing. Forty of the 50 infrapopliteal arteries successfully dilated were occluded, with a mean (+/-SD) lesion length of 18.0 +/- 3.5 cm. After the procedure, TCO2 improved from 27.82 +/- 9.97 mm Hg (95% confidence interval [CI] 23.95 to 31.69) to 54.5 +/- 14.73 mm Hg (95% CI 48.79 to 60.21, p < 0.0001), whereas the ABI did not (p > 0.2). TCO2 predicted procedural and clinical success (p < 0.0182). CONCLUSIONS: Infrapopliteal transcatheter interventions in diabetic patients may salvage the majority of limbs doomed to amputation. Although TCO2 measurements are valuable in predicting wound healing and success after interventions, ABI measurements are not.

Angiography↗
PubMed1997

Serum concentrations of free ubiquitin and multiubiquitin chains.

Ubiquitin, which can conjugate with cellular proteins, is classified into two forms: free ubiquitin and multiubiquitin chains. The latter is active as a signal for degradation of the targeted proteins. We found both forms in human serum and, using two immunoassays, quantitated them in sera from healthy subjects and patients with some diseases. Because of putative leakage of erythrocyte ubiquitin, hemolytic serum and serum obtained after long incubation (> 1-2 h) of blood at room temperature were excluded. Serum concentrations of multiubiquitin chains and free ubiquitin were substantially higher in rheumatoid arthritis and hemodialysis patients, respectively, than healthy subjects. Additionally, in acute viral hepatitis, serum multiubiquitin chain concentrations were increased in the acute phase, decreased in the recovery phase, and correlated with alanine and aspartate aminotransferase activities (r = 0.676 and 0.610, P < 0.0001 and < 0.001, respectively). Therefore, serum ubiquitin may have prognostic value.

Acute Disease↗
PubMed1996

Respiratory effects of CO2 pneumoperitoneum during transperitoneal laparoscopic urological surgery.

OBJECTIVE: To evaluate the effects of CO2 pneumoperitoneum on respiratory function during urological laparoscopic surgery with exposure of the retroperitoneal space in the lateral decubitus position. METHODS: Arterial blood gas analysis and measurements of the partial pressure of CO2 in exhaled gas (PetCO2) were performed during CO2 pneumoperitoneum in 12 patients who underwent transperitoneal laparoscopic surgery for the retroperitoneal organs (the retroperitoneal group): the results were compared to those of 11 patients who underwent laparoscopic varicocelectomy (the varicocele group) with the same anesthesia and intra-abdominal pressure. RESULTS: The increase in PaCO2 and PetCO2 and the decrease in arterial pH during CO2 insufflation were significantly greater in the retroperitoneal group than in the varicocele group. PaCO2, PetCO2 and arterial pH continued to change in the retroperitoneal group, whereas these values reached a plateau at 30 min after the beginning of CO2 insufflation in the varicocele group. CONCLUSIONS: The respiratory effects of CO2 pneumoperitoneum are more pronounced during laparoscopic urological surgery with opening of the retroperitoneum. It is possible that exposure of the retroperitoneal space increased CO2 absorption during insufflation.

Adult↗
PubMed1996

Catecholamine release caused by carbon dioxide insufflation during laparoscopic surgery.

PURPOSE: We evaluated plasma catecholamine levels during pneumoperitoneum in laparoscopic surgery. MATERIALS AND METHODS: Plasma epinephrine and norepinephrine were evaluated in 29 patients who underwent laparoscopic retroperitoneal surgery in a half lateral decubitus position (group 1) or laparoscopic varicocelectomy in a Trendelenburg position (group 2). RESULTS: The levels of epinephrine and norepinephrine increased significantly 5 minutes after carbon dioxide insufflation compared to levels after Veress needle insertion and just before insufflation. The elevation of catecholamine levels during laparoscopic procedures was greater in group 1. CONCLUSIONS: Our results indicate that carbon dioxide insufflation may cause catecholamine release during laparoscopic surgery. Careful monitoring of hemodynamics is mandatory at the beginning of the procedure.

Adolescent↗
PubMed1996

[Clinical significance of serum levels of human hepatocyte growth factor in patients with acute viral hepatitis].

We studied the relationship of serum levels of human hepatocyte growth factor (hHGF) to causative viruses and clinical features in 63 patients at our hospital with serologically diagnosed acute viral hepatitis. Serum levels of hHGF were not correlated with the type of hepatitis virus (A, B, and C) during the acute phase (p < 0.60) but were correlated with results of the hepaplastin test (p < 0.01). Furthermore, the difference in serum levels of hHGF between severe (levels on hepaplastin test < 40%) and nonsevere cases of hepatitis was significant (p < 0.001), and serum levels of hHGF became normal as levels of alanine aminotransferase decreased. However, serum levels of hHGF in prolonged cases of hepatitis (time until normalization of alanine aminotransferase > 13 weeks) tended to be slightly lower than in nonprolonged cases (p < 0.47). These results suggest that serum levels of hHGF are useful to determine the prognoses of patients with severe hepatitis and to estimate the time until liver damage heals.

Acute Disease↗
PubMed1995

Orotracheal intubation through the laryngeal mask airway in paediatric patients with Treacher-Collins syndrome.

The laryngeal mask airway (LMA) is useful as an airway intubator (conduit) for an intubating tracheal bougie or fibreoptic bronchoscope, over which a tracheal tube is passed. However, in our paediatric patients with Treacher-Collins syndrome, only the latter technique was successful. This was attributed to the fact that a posteriorly protruded tongue displaced the LMA, made the glottis move considerably anterior and interfered with the attempts to enter the trachea with a bougie. Downward displacement of the epiglottis, which can sometimes impair the intubation technique through the LMA, was not observed in our patients. Partial obstruction of a tracheal tube within the LMA occurred in one of the patients.

Airway Obstruction↗
PubMed1995

[Investigation on change of acquired antibodies in responders against hepatitis B vaccine].

Changes of titers of acquired hepatitis B surface (HBs) antibodies against HB vaccine were investigated by measuring them again after a long lapse of time. Ten micrograms of the recombinant HB vaccine was intramuscularly injected respectively to the staff of the authors' hospital three times. Four weeks after a full course of the vaccination 185 persons could acquire antibodies, whose titers were 2.0 or more in cut off index (C.I.) by radioimmunoassay (RIA). Of these members titers of antibodies of 48 subjects could be remeasured for the first time 38 months after the measurement of the titers in the 4th week after a full course of the vaccination. Four weeks after the last vaccination 7 persons were high responders whose titers of antibodies were 50 or more in C.I. 29 were medium responders with their titers from 49 to 10, and 12 were low responders having titers of less than 10. However, 38 months after the course the titers of those responders decreased so much that nobody remained highly responders, 22 were low responders, and the remaining 22 turned to be negative again with titers less than 2.0. Supposing that the titer of antibody enough to protect the infection of HB virus is 10 or more in C.I., 32 of 36 persons needed booster shots 38 months later because their titers dwindled down to less than 10.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗