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Biomedical subjects

K Soma

Publications and source records attributed to K Soma.

At least 73 records · Page 4Linked to original sources
PubMed1998

Evaluation of potential fat emboli during placement of intramedullary nails after orthopedic fractures.

STUDY OBJECTIVE: To evaluate material with high echogenicity demonstrated by transesophageal echocardiography (TEE) during the reamed intramedullary nailing procedure in long-bone fracture patients, and to analyze BAL fluid (BALF) in these patients as well as in those with the fat embolism syndrome (FES). DESIGN: Prospective cohort study. SETTING: Emergency and critical care center of a university hospital. PATIENTS: Fifteen patients with long-bone fractures in whom reamed intramedullary nailing was performed, and five patients diagnosed with FES. MEASUREMENTS: During reamed nailing procedures, TEE was performed. We measured the differential cell counts, percentage of lipid-laden cells, and albumin concentration in BALF after the operation. We compared TEE findings and BALF analysis in the surgical patients. In addition, we compared BALF findings in the surgical patients and in the FES patients. RESULTS: We divided 15 patients who underwent TEE into three subtypes based on the appearance of embolic material within the chambers of the right heart. The lipid-laden cells in BALF increased significantly in those patients with highly echogenic material by TEE (p < 0.05). The percentage of the lipid-laden cells in BALF was not significantly different between the TEE patients and those with FES. On the other hand, FES patients showed a statistically significant increase in leukocyte counts and albumin concentration (p < 0.05). CONCLUSIONS: The highly echogenic material seen in TEE during reamed intramedullary nailing could be fat globules on the basis of BALF analysis. However, all patients with large emboli by TEE do not develop FES. A factor other than mechanical obstruction by fat globules may be necessary for the development of FES.

Adolescent↗
PubMed1998

Fatal bilateral adrenal hemorrhage following acute toluene poisoning: a case report.

CASE REPORT: A 19-year-old woman was admitted to the emergency center with the development of quadriparesis after prolonged inhalation of lacquer thinner (67% toluene). Laboratory findings were compatible with a distal renal tubular acidosis manifest as metabolic acidosis, hypokalemia, and hyperchloremia. Despite potassium replacement, her condition deteriorated drastically 30 hours later. Blood pressure became refractory to vasopressors, temperature was persistently above 40 degrees C, and death occurred 56 hours later. At autopsy, adrenal insufficiency secondary to bilateral adrenal hemorrhage was diagnosed. Bilateral adrenal hemorrhage should be considered as a potential cause of sudden clinical deterioration during treatment of serious toluene intoxication.

Acidosis, Renal Tubular↗
PubMed1998

Survival after massive arsenic poisoning self-treated by high fluid intake.

CASE REPORT: A 23-year-old male pharmacist ingested 1040 mg arsenic trioxide (788 mg trivalent arsenic, 13 mg/kg). After 7 asymptomatic hours, frequent vomiting and diarrhea occurred. Fearing death from shock, he drank 5 L of water over 5 hours. When he was brought to our hospital with chief complaint of constricted vision about 20 hours after ingestion, the major abdominal symptoms had already subsided. Despite a lethal plasma arsenic on admission, all toxic symptoms including hepatic dysfunction, erythematous dermal eruption, and peripheral neuropathy improved during his hospital stay with no treatment except for dimercaptopropanol.

Adult↗
PubMed1997

Glutamate receptor subunits GluR5 and KA-2 are coexpressed in rat trigeminal ganglion neurons.

To determine the subunit composition of high-affinity kainate receptors in native neurons is a challenging problem because of the expression of more than one GluR subunit. In the present study the question of whether GluR5 and/or GluR6 subunits combine with KA-1 or KA-2 subunits in vivo is addressed by performing detailed physiological, pharmacological, and molecular characterization of functional kainate receptor channels in acutely dissociated trigeminal ganglion (TG) neurons. The results show that (1) smaller diameter TG neurons (<30 microm) respond to L-glutamate and kainate, and the currents gated by kainate desensitize with prolonged agonist exposure; (2) all kainate receptor subunits are detected to some extent by reverse transcriptase-PCR, whereas glutamate receptor subunits GluR5 and KA-2 are expressed at high levels in the TG; (3) there is an obvious similarity between the features of native kainate receptor channels in TG neurons and of heteromeric recombinant GluR5(R)/KA-2 channels in pharmacological properties, desensitization, rectification, ion permeability, and mean channel conductance; and (4) the age-dependent increase in GluR5 and KA-2 RNA levels in the TG is correlated well with an increased number of kainate-sensitive cells during postnatal development. Our data suggest that the heteromeric GluR5/KA2 combination actually occurs in TG neurons and give a clue as to the subunit composition of native kainate receptor channels.

Animals↗
PubMed1997

The pulmonary hemodynamic effects of 1,1,1-trichloroethane inhalation.

We examined the hemodynamic effects of 1,1,1-trichloroethane (TCE) inhalation in anesthetized dogs in acute inhalation experiments. Six adult mongrel dogs with spontaneous respiration were intubated, connected to a one-way valve. TCE was delivered by the tubular system connected to a 30-liter tedlar bag reservoir filled with 1 v/v% of TCE. After TCE inhalation, the animals revealed a significant decrease in systemic arterial pressure following a decrease in systemic vascular resistance. Pulmonary arterial pressure, pulmonary vascular resistance and right cardiac work increased significantly. These changes were compatible with clinical manifestations of TCE intoxication in human beings. In conclusion, inhalation of TCE may not only decrease peripheral vascular resistance, but also induce transient disturbance of pulmonary blood flow with subsequent pressure overloading in the right ventricle.

Analysis of Variance↗
PubMed1997

Concentration in blood and organs of dogs after high dose 1,1,1-trichloroethane inhalation.

Dogs were exposed to 1% (v/v) (10,000 ppm) vapor of 1,1,1-Trichloroethane (1,1,1-TCE) by inhalation for 3 min repeated four times at 4 hr intervals under continuous anesthesia. Changes in the 1,1,1-TCE concentration in blood with time, as well as distribution of 1,1,1-TCE in the organs and tissues (lungs, liver, kidneys, heart, brain, and fat around the kidneys and on the abdominal wall) upon completion of the four exposures were studied. Concentrations of 1,1,1-TCE in blood showed the highest level immediately after exposure, and fairly decreased in about 30 min after exposure. The half life of 1,1,1-TCE in blood was 4-12 min after exposure. Upon completion of the exposures (3 min inhalations repeated four times), 1,1,1-TCE concentrations per gram wet weight of each organ ranged from 0.1 to 0.5 microgram/g in the lungs, liver, kidneys, heart and brain. On the other hand, the 1,1,1-TCE concentration in fat ranged from 16.9 to 54.6 micrograms/g, greatly exceeding those in other organs.

Adipose Tissue↗
PubMed1996

[A case of severe acute hepatorenal failure due to Aeromoas hydrophila septicemia].

A case of septicemia due to Aeromonas hydrophila (A. hydrophila) in a 54-year-old male suffering from progressive severe jaundice and fatigue is reported. The patient developed multiple organ failure despite aggressive therapy including plasma exchange and glucose-insulin therapy. Upon admission to our hospital, therapy was started with ampicillin (ABPC) 4 g/day, gentamicin (GM) 120 mg/day, hemodialysis, continuous hemofiltration, catecholamines and a respirator, but he expired on the 2nd hospital day. Blood culture and histology revealed A. hydrophila. Postmortem examination showed alcoholic liver fibrosis which was most likely liver cirrhosis. In the literature, patients with septicemia due to Aeromonas had underlying hepatic cirrhosis more often than did those with septicemia due to other gram-negative bacilli. Therefore, it is important-to consider the possibility of liver cirrhosis in patients with A. hydrophila septicemia.

Aeromonas hydrophila↗
PubMed1996

[Measurement of adenosine deaminase activity in bronchoalveolar lavage fluids as a tool for diagnosing miliary tuberculosis].

Measurement of the activity of adenosine deaminase (ADA) in pleural effusions has been reported to be useful in the diagnosis of tuberculous pleuritis. To determine whether ADA activity can also be used to diagnose miliary tuberculosis, it was measured in bronchoalveolar lavage fluid from 64 subjects: 6 patients with miliary tuberculosis, 21 patients with sarcoidosis, 15 patients with idiopathic interstitial pneumonia, 15 patients with other diseases, and 7 healthy controls. Mean ADA activity was 5.02+/-3.75 IU/L (mean+/-SD) in patients with miliary tuberculosis; 1.06+/-0.99 IU/L in patients with sarcoidosis; 0.21+/-0.43 in patients with idiopathic interstitial pneumonia; and 0.30+/-0.51 IU/L in healthy controls. The level in patients with miliary tuberculosis differed significantly from the others (p<01.01). All 6 patients with miliary tuberculosis, 3 patients with sarcoidosis, 1 patient with Wegener's granulomatosis, and 1 patient with lymphangitic carcinomatosis had levels of ADA activity in bronchoalveolar lavage fluid that exceeded 2.0 IU/L. With a cut-off value of 2.0 IU/L the sensitivity of this test to miliary tuberculosis is higher than that of other diagnostic aids. Measurement of ADA activity in bronchoalveolar lavage fluid may be of great value in the early diagnosis of miliary tuberculosis.

Adenosine Deaminase↗
PubMed1996

[Clinical studies on vancomycin in the treatment of MRSA infection].

We evaluated the effectiveness and safety of vancomycin (VCM) alone and in combination with beta-lactam antibiotics in the treatment of MRSA infections, and obtained the following results: 1. Effectiveness. (1) In cases of MRSA infections alone, the improvement rate was 71.4% (5/7 patients) with VCM alone and 77.8% (35/45) with VCM in combination with beta-lactam antibiotics. (2) In cases of polymicrobial infections, few cases were treated with VCM alone, but the improvement rate in combination use with beta-lactam antibiotics was 71.8% (28/39). 2. Bacteriological effect. (1) In cases of single infection with MRSA, the rate of bacterial eradication was 71.4% (5/7) with VCM alone and 68.2% (30/44) with VCM in combination with beta-lactam antibiotics. (2) In cases of polymicrobial infections, few cases were treated with VCM alone, but the rate of bacterial eradication in combination use with be ta-lactam antibiotics was 63.2% (24/38) against MRSA and 31.6% (12/38) against polymicrobial agents including MRSA. 3. Safety. Occurrences of adverse reactions and abnormal laboratory test values when VCM was used alone or when it is used in combination with another drug were about the same in these uses. As a whole, advance reactions were observed in 16 patients (9.5%). Main adverse reactions were whole body redness, drug eruption, and rash etc. Abnormal laboratory test values were observed mainly in hepatic functions, and renal functions. 4. VCM concentrations in blood was determined in 38 patients. Doses of 0.5 g and 1.0 g of VCM was administered by intravenous drip infusion over a period of 1 to 2 hours, and mean blood concentrations 1 to 2 hours after the completion of drip infusion were 25.4 micrograms/ml and 14.4 micrograms/ml, respectively. 5. Synergic effects between VCM and other antibiotics tested were observed in FIC index against all of the six MRSA strains isolated from six patients, and the clinical effects of improvement or better were obtained against five of them.

Adolescent↗
PubMed1995

Wegener's granulomatosis complicated by arterial aneurysm.

Wegener's granulomatosis is a distinct clinicopathologic entity characterized by granulomatous vasculitis of the upper and lower respiratory tract and kidneys. A 56-year-old Japanese man with Wegener's granulomatosis died of intraperitoneal hemorrhage from a ruptured aneurysm of his left gastric artery. Histological findings revealed necrotizing granulomatous vasculitis involving this artery. No previously published reports have described Wegener's granulomatosis patients with aneurysms in such a large artery. We conclude that this case represents either an atypical form of Wegener's granulomatosis or a polyangiitis overlap syndrome of Wegener's granulomatosis and classic polyarteritis nodosa.

Aneurysm↗
PubMed1995

[Jaw position, head position, body posture: development of an integrated system of examination, Part I].

Recently in the field of clinical orthodontics, there has been increased interest in the relationship between jaw and head position, sleep apnea, and equivocal symptoms occurring in head, neck and shoulder. It has already been determined that a relation exists between head posture and mode of breathing. Since the craniofacial skeleton is supported by the cervical, thoracic and lumbar vertebrae, the head position might have some biomechanical connection to total body posture. Therefore, an integrated system of examining jaw position, head position and body posture is being developed.

Biomechanical Phenomena↗
PubMed1995

[Basic evaluation of nitric oxide inhalation therapy].

We studied the site of action of nitric oxide (NO) and the dose-response relationship between inhaled NO and PaO2. We also measured nitrosyl-hemoglobin (Hb-NO) levels in arterial and mixed venous blood and NO2 levels in our NO inhalation system to confirm the safety of NO inhalation. In an ovine model of ARDS induced by lung lavage, pressure-flow plots indicated that the site of action of inhaled NO was close to the alveoli. During hypoxia, pulmonary artery pressure decreased as the concentration of inhaled NO increased; PaO2 peaked at 10-20 ppm NO. The levels of Hb-NO in arterial and mixed venous blood during inhalation of 40-60 ppm NO under hypoxic conditions were greater than the levels under normoxic conditions, but Hb-NO still accounted for less than 0.1% of the total Hb. Less than 0.1 ppm on NO2 was generated during inhalation of 5 ppm NO. In conclusion, inhaled NO can dilate pulmonary vessels near alveoli without lowering the O2 carrying capacity of blood. In the present system, only a negligible amount of NO2 was produced.

Administration, Inhalation↗
PubMed1994

[A case of adult respiratory distress syndrome treated with 5 ppm nitric oxide inhalation].

A cases of adult respiratory distress syndrome, ARDS, was treated with nitric oxide (NO) inhalation for 10 days. The optimal dose of inhaled NO was determined by the dose-response relationship with NO concentration ranging from 5 to 160 ppm. 5 ppm of NO inhalation considerably increased PaO2 and decreased mean pulmonary arterial pressure (mPAP). Further increase in concentration of inhaled NO did not result in remarkable change in PaO2, but decreased mPAP. NO inhalation therapy was begun with 20 ppm of NO and 0.95 of FIO2, and on the 6th day NO concentration was decreased to 5 ppm with 0.7 of FIO2. In this case of ARDS, FIO2 could be sufficiently decreased and PaO2 maintained at more than 60 Torr with 5 ppm NO inhalation.

Administration, Inhalation↗
PubMed1994

[A clinical study of fulminant Legionnaires' disease].

Seven cases of fulminant Legionnaires' disease treated at Kitasato University Hospital between 1985 and 1992 were reviewed. These patients were male with a mean age of 55.9 years (range, 37-67 yrs), and five were heavy alcohol drinkers. All seven patients required mechanical ventilation. Four patients recovered (group 1) and three expired due to respiratory failure (group 2). The mean interval from initial symptoms to the development of respiratory failure was 8.8 days in group 1 and 6.0 days in group 2, except in the one patient with lung cancer (case 6). The progression of pneumonia was more rapid in group 2. The mean intervals from admission to administration of erythromycin were 1.5 days and 3.5 days, respectively, in groups 1 and 2. In group 1, pulmonary infiltrates and respiratory insufficiency worsened for the first few days after erythromycin administration but improved thereafter. The average duration of ventilatory care in group 1 was 13.3 days. The administration of rifampicin combined with erythromycin may be useful for the treatment of fulminant Legionnaires' disease. When fulminant pneumonia is encountered in a middle-aged or elderly male alcoholic, Legionnaires' disease should be suspected and erythromycin administration with rifampicin should be initiated as early as possible.

Adult↗