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Biomedical subjects

N Honda

Publications and source records attributed to N Honda.

At least 127 records · Page 7Linked to original sources
PubMed1993

[The alteration of right ventricular performance in patients with pneumonectomy and pulmonary lobectomy].

Elevation of right ventricular afterload associated with the decrease of pulmonary vascular bed is a serious problem immediately after pneumonectomy. We studied the alteration of right ventricular performance and hemodynamics by using an RVEF thermodilution catheter, and compared them among 6 patients after pneumonectomy and 8 patients after pulmonary lobectomy. Results demonstrate that 1) PVRI increased significantly immediately after the pneumonectomy, and recovered to the preoperative level on the 1st postoperative day. On the other hand, in the lobectomy patients, PVRI showed no significant change throughout the operation, because the decrease of pulmonary vascular bed after pneumonectomy was larger than that after pulmonary lobectomy. 2) In the pneumonectomy group, CI and RVEF were preserved and right ventricular works (RCWI and RSWI) increased in spite of an increase of right ventricular afterload after the ligation of the pulmonary artery. We considered that immediately after pneumonectomy the increase of right ventricular afterload associated with decreased pulmonary vascular bed was compensated by increasing right ventricular work. 3) On the 1st postoperative day, CI and RVEF did not change, but mRAP decreased significantly, and PVRI and right ventricular works recovered to the preoperative level in the pneumonectomy patients. From the above results, we considered that after the pneumonectomy, increased right ventricular afterload was compensated by the decreased circulating blood volume.

Hemodynamics↗
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h after the beginning of the operation at which aortic clamp was removed and reached a peak after 4 h at which CPB was withdrawn.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

[Spindle cell carcinoma of the urinary bladder: a case report].

A 74-year-old man with spindle cell carcinoma of the urinary bladder is reported. He presented to our clinic with gross hematuria resulting in bladder tamponade. Transurethral resection (TUR) was performed in order to control severe hematuria intractable with conservative therapy. Histologically the tumor invaded the muscle layer and was composed of two components, small foci of transitional cell carcinoma and numerous spindle cells with severe atypia and then the transition was recognized between them. Immunohistochemically transitional cell carcinoma was intensely positive for cytokeratin (CK) and epithelial membrane antigen (EMA), but negative for vimentin (VIM). Moreover some parts of spindle cells were weakly stained for CK and EMA. Three months after TUR, multiple pulmonary metastases and moderate right hydronephrosis occurred and he died of respiratory insufficiency one month later.

Aged↗
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

[Anesthetic consideration of a patient with congenital insensitivity to pain with anhidrosis].

Congenital insensitivity to pain with anhidrosis is a rare disorder but several clinical anesthetic experiences have been reported in Japan. We anesthetized a patient with this disorder for orthopedic operation with a low concentration of sevoflurane under monitoring of body temperature and we measured the concentrations of plasma ADH, cortisol and catecholamines levels before, during and after the operation. There were no problems during anesthesia and the patient awoke rapidly. ADH, cortisol and epinephrine concentrations showed slight elevations during and after the operation. The management of intraoperative body temperature and the necessary level of anesthesia were also discussed.

Adolescent↗
PubMed1993

[Dual-energy data acquisition for simultaneous 81mKr ventilation/99mTc-MAA perfusion SPECT: ventilation/perfusion ratio mapping in cross section].

Methods of simultaneous pulmonary ventilation/perfusion (V/Q) tomogram (SPECT) for V/Q ratio mapping were reported. Crosstalk was corrected by subtraction assuming crosstalk/signal ratio is constant for an individual examination. Crosstalk was reduced by 85% for that of 99mTc-to-81mKr window (R12), and by 83% for that of 81mKr-to-99mTc window (R21) in a phantom experiment. The R12 and R21 were 1.0-1.9% (mean 1.3%) and 34.6-55.3% (mean 41.9%), respectively in 9 patients (mean age, 56.1 years; range, 38-82 years). V/Q SPECT was undertaken in 7 of the 9 patients. 99mTc-macroaggregated albumin (185 MBq) was injected intravenously in supine position, and 81mKr gas was administered continuously during the SPECT data acquisition. Sixty-four 64 x 64-matrix (size = 8 mm/pixel) images, 20-second acquisition time for each, were collected by a rotating gamma camera in a step-and-shoot fashion during a 360-degree rotation with the two photopeaks, one at 140 keV for 99mTc and another at 190 keV for 81mKr. Examination time was about 40 minutes, and the V/Q ratio maps in cross section were obtained in all of the examinations.

Adult↗
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

[Radionuclide studies of atherosclerosis].

New Tc-99m-labeled brain perfusion imaging agents, such as Tc-99m-HMPAO, and Tc-99m-ECD, are developed and expected to improve the clinical study of cerebral perfusion disturbance due to arteriosclerosis. They enable us better images than I-123-IMP and more accurate diagnosis. Similarly, in the field of cardiovascular nuclear medicine, new Tc-99m-labeled compounds, Tc-99m-MIBI, Teboroxime and Tetrofosmin are available. Furthermore, I-123-MIBG, a tracer taken up in presynaptic adrenergic vesicles, and I-123-BMIPP, a new agent developed for the evaluation myocardial fatty acid metabolism, will mark a new epoch in the study of coronary sclerosis. In order to image atherosclerosis directly, In-111-polyclonal immunoglobulin G, Tc-99m-low density lipoprotein etc., are under investigation.

Amphetamines↗
PubMed1993

[The changes of intraocular pressure during sevoflurane anesthesia in children].

We investigated the intraocular pressure (IOP) during sevoflurane anesthesia in 20 children. We measured IOP, mean blood pressure and heart rate at 7 points in each subject. IOP was measured first after induction, then after vecuronium administration, immediately after intubation, and 5, 10, 15, 30 min after intubation. There were no significant changes in IOP and hemodynamics during sevoflurane anesthesia. We consider that the optimal time for IOP measurement is 5 or 10 min after intubation and the normal range of IOP is within the mean +/- 2 standard deviation. The peak values of IOP were 19.2 and 18.8 mmHg at 5 and 10 min after intubation. The results suggest that normal range of IOP is below 20 mmHg during sevoflurane anesthesia in children.

Anesthesia, Inhalation↗
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↗
PubMed1993

[Congenital oropharyngeal wall stenosis: a case of difficult endotracheal intubation].

We experienced a case of difficult endotracheal intubation. The patient was a 43 year-old female with congenital oropharyngeal wall stenosis. She was suffering from fibromyoma of uterus and an operation was scheduled under general anesthesia. Her natural voice was nasal. She denied having any respiratory difficulty or difficulty in swallowing. Respiratory function test revealed a low peak flow but the other data were normal. Preceding endotracheal intubation, at laryngoscopy we noticed a stenosis of upper airway because of the web, extending from the middle pharynx to soft palate and its diameter was about 1 cm. Ordinary endotracheal intubation was impossible because of the stenosis. In this case, fortunately we succeeded fiberoptic endotracheal intubation under spontaneous respiration. We conclude that the examination of the pharynx is very important during the perioperative period.

Adult↗
PubMed1993

[Comparison between 180 degrees and 360 degrees data collection in 99mTc-Tetrofosmin SPECT of the myocardium].

We compared 360 degrees data collection technique with 180 degrees technique in SPECT using a new myocardial perfusion imaging agent, 99mTc-Tetrofosmin. Eight patients were examined at stress and at rest on separate days. Following the injection of 555 MBq 99mTc-Tetrofosmin, 64 views of 15 sec each were collected during a 360 degrees rotation, and 32 views of 30 sec each during a 180 degrees rotation. The 180 degrees data collection provided superior images in sharpness in 14 of 16 scans. The interpretation was concordant in 123 of 128 regions (96.1%), and hypoperfusion was considered to be underestimated in 5 regions using the 360 degrees technique. It was suggested that the 180 degrees data collection technique is more effective in myocardial SPECT employing 99mTc-Tetrofosmin than the 360 degrees technique.

Aged↗
PubMed1993

Intraglomerular basement membrane translocation of immune complex (IC) in the development of passive in situ IC nephritis of rats.

A study was performed to elucidate the mechanisms of charge-based immune complex nephritis. A chronological observation after induction of nephritis was made by immunoelectron microscopy to clarify whether antigen (Ag) remains in association with antibody (Ab) and C3 during the translocation through the glomerular basement membrane (GBM). Fifteen minutes after intrarenal perfusion with cationized ferritin (pI > 10.0) as Ag, followed by injection of rabbit anti-ferritin Ab, deposition of subendothelial Ag-Ab-C3 complexes was observed. Between 2 hours and 1 day, a large number of Ag in close association with Ab was noted in the lamina densa, but only a small amount of C3 was detectable. During this time Ag and Ab in the subendothelial region gradually decreased. However, C3 reappeared in the subepithelial region together with the Ag-Ab complex after 1 day, and the subendothelial C3 significantly decreased. At 2 hours and day 1, the distributions of Ag and Ab in the GBM were similar in immersion-fixed kidneys regardless of the preperfusion with phosphate-buffered saline. On the other hand, the passage of Ag across the lamina densa was delayed in the experimental rats as compared with the controls. Significant albuminuria also appeared on day 1. Despite the general concept that Ab binding to cationized Ag results in low avidity immune complex, cationized Ag translocated across the GBM in close association with Ab. The complement was activated biphasically in the subendothelial and in the subepithelial space. The subendothelial complement activation may have contributed to the translocation of immune complex.

Albuminuria↗
PubMed1993

[Clearance of 99mTc-Tetrofosmin from the myocardium and the adjacent organs].

We studied clearance of a new myocardial perfusion imaging agent, 99mTc-Tetrofosmin, from the myocardium and the adjacent organs in nine patients. 99mTc-Tetrofosmin was injected intravenously at stress and at rest, and SPECT images were obtained 25 min and 120 min later. Anterior view images were also obtained 10 min and 150 min after the injection to compare the myocardial clearance with those from the liver and lung. Clearance from the liver was faster than those from the myocardium and lung. Washout rate calculated with SPECT was higher for the inferior wall than for the anterior wall and lateral wall (p < 0.05 at rest, N.S. at stress). The value was higher at stress in any region than at rest (the anterior wall and lateral wall, p < 0.01; the septum, p < 0.05; the inferior wall, N.S.). Washout rate for the anterior wall was 3.4 +/- 14.0% at rest and 18.0 +/- 10.6% at stress. The rate for the lateral wall was 2.7 +/- 22.5% at rest and 15.8 +/- 7.9% at stress. It was suggested that rapid hepatic clearance and high myocardial washout at stress may be important in determining the period between the injection of 99mTc-Tetrofosmin and the data acquisition for SPECT imaging.

Female↗
PubMed1993

[Clinical experience with extracorporeal shock wave lithotripsy using Dornier MFL 5000-(U) for urinary stone].

Our hospital recently installed one of the newest types of extracorporeal shock wave lithotripters, a Dornier MFL 5000-(U). We conducted preliminary clinical trials with the apparatus from April to June 1991. In this report we discuss our experience with the first 40 patients (52 stones) treated in a total of 52 extracorporeal shock wave lithotripsy (ESWL) sessions. Follow up observation was conducted for three months. Except in one case, invasive anesthesia was not used. A double J-catheter was inserted in 13 cases, a ureteral catheter in 7 cases, and percutaneous nephrolithotripsy (PNL) was used after ESWL in one case. After one month of follow-up, 27 patients (67.5%) were completely free from stone fragments, while at 3 months after treatment, 34 patients (85.0%) were free from stone fragments. No serious complications were observed after ESWL. We concluded that the Dornier MFL-5000-(U) apparatus is effective for renal and ureteral stones and generates no serious complications.

Adult↗
PubMed1993

[Reversal by the calcium ion of the pain threshold elevated by calcium channel blockers].

We investigated calcium ion effects on pain thresholds by iontophoresis in healthy adult volunteers. The pain thresholds were measured by the pain thermometer to evaluate the effect of iontophoresis. At first, one of calcium channel blockers (nicardipine, verapamil or diltiazem) was administered by iontophoresis with 1.0 mA for 10 minutes. Then, next to calcium channel blockers, calcium chloride or saline was locally administered after the elevation of pain threshold had been recognized and the pain threshold had been measured again. Calcium ion decreased the elevation of pain threshold significantly, but saline had no effect. These results suggest that not only sodium channel but also calcium channel influences pain mechanism during iontophoresis.

Adult↗
PubMed1992

[Two-dimensional time-of-flight MR angiography of mediastinum and pulmonary hilar vessels: initial clinical experiences].

Two-dimensional time-of-flight magnetic resonance angiography (2D TOF MRA) of mediastinal and pulmonary hilar vessels was performed in 10 patients, seven men and three women with a mean age (range) of 65.7 (48-88) years. The rate of visualization of the vessels and the diagnostic ability of 2D TOF MRA were assessed in comparison with contrast-enhanced CT. A radiofrequency-spoiled gradient echo sequence (SPGR) was used during repeated breath-holding (8-27 seconds) in coronal (8 patients) and axial (2 patients) imaging planes on a 1.5 Tesla superconducting scanner under the following conditions: repetition time/echo time/flip angle/excitation: 25-33/7-8 ms/45 degrees/1, field-of-view: 30 x 30 cm, slice thickness: 2.5 mm, 32 slices, 256 (frequency) x 192 (phase) matrix, with gradient moment nulling technique. Visualization sufficient to enable diagnosis of the vascular lesion was obtained in 95 (52%) vessels, mere visualization in 63 (35%), and non-visualization in 24 (13%) of the 182 evaluable vessels. The rates of good visualization of pulmonary hilar vessels (26/86, 30%) and veins (26/48, 54%) were significantly lower than that of arteries (43/48, 90%, p < 0.05). The sensitivity and specificity of 2D TOF MRA were 77% (10/13) and 100% (83/83), respectively, in 96 evaluable vessels of nine patients. 2D TOF MRA of mediastium and pulmonary hili is clinically feasible, and may be useful because of its high specificity.

Aged↗