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Biomedical subjects

N Ochiai

Publications and source records attributed to N Ochiai.

At least 55 records · Page 3Linked to original sources
PubMed1993

Protection by nicorandil against the dysfunction of the central vagal baroreflex system following transient global cerebral ischaemia in dogs.

1. A possible cerebroprotective effect of nicorandil was investigated in a canine model of 5 min global cerebral ischaemia, and compared with protective effects of nitroglycerin and nicardipine. 2. Cerebral ischaemia was produced by occlusion of the left subclavian and the brachiocephalic arteries with preceding ligation of the intercostal arteries. The decrease in baroreflex sensitivity (BRS), measured by phenylephrine-induced reflex bradycardia, was used to assess the cerebroprotective effect. 3. Nicorandil (10 or 30 micrograms kg-1 min-1, i.v.), nitroglycerin (3 micrograms kg-1 min-1, i.v.) or nicardipine (0.3 micrograms kg-1 min-1, i.v.) were infused for 60 min just before ischaemia. Nitroglycerin and nicardipine decreased mean arterial blood pressure to an extent similar to that induced by the lower dose of nicorandil. Blood flow in the dorsal medulla oblongata was increased by nicorandil and nicardipine, but not by nitroglycerin. 4. Nicorandil at both doses and nitroglycerin prevented the post-ischaemic decrease in BRS. In these cases, bilateral vagotomy during the reperfusion period decreased BRS, indicating that the vagal component of BRS was protected from ischaemia. On the other hand, nicardipine failed to exert a cerebroprotective effect. 5. The present study suggests that nicorandil may possess a direct cerebroprotective effect and that its property as a nitrate might, at least in part, be important for the observed cerebral protection.

Animals↗
PubMed1993

[Anesthetic management of a patient with polyarteritis nodosa who suddenly developed cardiac rupture after valve replacement].

We recently encountered a patient with mitral insufficiency, accompanied by PN (polyarteritis nodosa), who developed a cardiac rupture immediately after a mitral valve replacement. The patient was a 60-year-old woman. After she was diagnosed as having mitral stenosis and insufficiency in 1968, the patient developed congestive heart failure and underwent repeated hospital admissions and discharges. In 1989, she was diagnosed as having PN and began to receive a high-dose steroid therapy (prednisolone; total dose 5245 mg). Because of transient brain ischemia and exacerbation of the symptoms of heart failure, the patient underwent mitral valve replacement on December 19, 1991. For anesthesia, oxygen, fentanyl, midazolam and vecuronium were administered. During surgery, catecholamine, nitroglycerin and prostaglandin E1 were continuously infused intravenously. The patient was weaned smoothly from the cardiopulmonary bypass. The operation was completed in about 6 hours. Her postoperative course was satisfactory until she suddenly developed left ventricular rupture and died 6 hours after surgery. The rupture seemed to be attributable to a weakening of the myocardial wall following long-term, high-dose steroid therapy, and to myocardial degeneration caused by PN-associated necrotizing vasculitis of myocardial arterioles.

Female↗
PubMed1993

[Anesthetic management for cesarean section of a patient with transient diabetes insipidus and acute severe liver dysfunction].

A 26-year old woman presented with acute hepato-renal dysfunction, coagulation abnormalities and diabetes insipidus associated with hypernatremia in the latter term of pregnancy (39 weeks). Such transient diabetes insipidus during pregnancy as in this case has been reported to be resistant to AVP, but to respond to DDAVP. Because of fetal compromise, an urgent cesarean section was performed. Spinal anesthesia was chosen because of the possible deleterious effects of general anesthesia on liver function. After delivery of twin babies, her symptoms recovered gradually. In conclusion, diabetes insipidus during pregnancy as in this case is transient and disappear after delivery. However, multiple organ dysfunction may become worse and cause fetal death, unless surgical procedure with appropriate anesthetic management is performed.

Acute Disease↗
PubMed1993

[Successful anesthetic management of a patient with a giant mediastinal tumor].

Because of its anatomical location, mediastinal tumor is frequently accompanied by airway stenosis and signs indicating compression of the heart and large vessels. For this reason, a patient with this tumor often requires an urgent operation. We recently conducted such an operation on a girl 2 year and 7 month old in whom a giant tumor originating from the posterior mediastinum had caused dyspnea. In this case, anesthesia was induced with ketamine. Intubation was carried out while the girl was semiawake. No muscle relaxants were used, and spontaneous ventilation was partially preserved. During the operation, anesthesia was maintained with oxygen, nitrous-oxide and halothane, without using muscle relaxants. Although intratracheal bleeding, caused by manipulation of the tumor, aggravated the blood gas data, this could be coped with by elevating the oxygen concentration in the inspired gas. During the operation, respiratory control with 10cmH2O PEEP was carried out to cope with atelectasis from lung compression by the tumor. The postoperative course was excellent. From anesthetic management of this case we emphasize the following points: (1) preoperative assessment of the relationship between posture and dyspnea and assessment of the locational relationships of the tumor, heart, vessels and trachea, using CT, ultrasonography, bronchoscopy, etc; (2) utilizing a pulse oximeter, monitoring CO2 in expired gas and monitoring CVP during operation; (3) avoidance of the use of muscle relaxants before the improvement of the symptoms arising from tumor-caused compression; and (4) close respiratory care after operation.

Anesthesia↗
PubMed1992

Restoration of elbow flexion in root lesions of brachial plexus injuries.

A retrospective review of 87 patients with loss of elbow flexion secondary to root injuries of the brachial plexus was carried out. Results of nerve grafting, direct nerve transfer with the intercostal nerve, or tendon transfer were analyzed, and treatment recommendations were developed. Nerve transfer provided good or excellent results for injuries that included avulsion of the C5 and/or C6 roots. Nerve grafts were used successfully in cases of single or combined ruptures of C5 and C6. Tendon transfers provided good or excellent results in C5-C6 or C5-C7 avulsions, where nerve grafting was not possible and transferable muscles had good strength. Somatosensory evoked potentials were necessary to demonstrate nerve root avulsions in cases in which the roots appeared ruptured on visual inspection.

Adolescent↗
PubMed1992

Protection by halothane of the vagal baroreflex system from transient global cerebral ischemia in dogs.

A possible cerebroprotective effect of halothane was investigated in a canine model of 5-min global cerebral ischemia. In pentobarbital-anesthetized dogs, additional inhalation of 0.5 to 1% halothane prior to ischemia prevented the post-ischemic dysfunction of the vagal component of reflex bradycardia. In contrast, pretreatment with thiopental at 10 mg/kg, i.v. failed to prevent it. The influence of ischemia in the absence of anesthetics was similar to that under barbiturate anesthesia. The results suggest that halothane, but not barbiturate, may actively protect the vagal baroreflex system from ischemia.

Administration, Inhalation↗
PubMed1989

Usefulness of myelography in brachial plexus injuries.

Ninety brachial plexus lesions have been examined by myelography and the results classified into six types. These were compared against the level of lesion found at exploration of the brachial plexus with electrophysiological investigations carried out during the operation. The results show that myelography can be a reliable and useful pre-exploratory measure to assess the level of the lesion of each injured root.

Adult↗
PubMed1989

Direct nerve crossing with the intercostal nerve to treat avulsion injuries of the brachial plexus.

One hundred seventy-nine patients with root avulsion brachial plexus injuries were treated with direct nerve crossing with the intercostal nerve and 159 cases were followed more than 1 1/2 years after the operation. When suture was done to the musculocutaneous nerve, 90% of 10 children who had operation within 7 months of injury and 81.8% of 110 adults, younger than 40 years with operation within 6 months of injury regained grade 3 or 4 elbow flexion power. This direct method seems to produce better results than those of nerve crossing, which uses intermediary nerve grafts.

Adolescent↗
PubMed1989

Shoulder arthrodesis by external fixation.

The choice of pin site in shoulder arthrodesis after brachial plexus injury is important for efficient external fixation. The pins are inserted into the coracoid process from the anterior aspect and the scapular spine from the acromion. This insertion method holds the scapula more rigid and allows the patient to lie supine. Moreover, it makes it possible to correct the fixation angle after the operation. In 11 cases of brachial plexus injury, solid bony arthrodesis was obtained within three months.

Adult↗